Heart valve surgery

Overview

Heart valve surgery is a treatment for some types of heart valve disease. Heart valve disease happens when one or more of the four heart valves don't work as they should. Heart valves keep blood flowing the right way through the heart.

The four heart valves are the:

• Aortic valve.
• Mitral valve.
• Tricuspid valve.
• Pulmonary valve.

In heart valve surgery, a surgeon fixes or replaces a damaged or diseased heart valve. This may be done as an open-heart surgery or minimally invasive heart surgery.

The type of heart valve surgery done depends on:

• Age.
• Overall health.
• Symptoms.
• The type of heart valve disease.
• How severe the heart valve disease is.

Types

Why it's done

Heart valve surgery is done to treat heart valve disease. Types of heart valve disease include:

• Stenosis. The valve flaps are thick or stiff. They sometimes join together. The valve opening gets narrowed.
• Regurgitation. The valve flaps may not close tightly. Blood can leak backward through the valve.
• Prolapse. The valve flaps get stretched out and floppy. They bulge backward like a parachute. This condition can lead to regurgitation.
• Atresia. The valve isn't formed. A solid sheet of tissue blocks the blood flow between the heart chambers. This type usually affects the pulmonary valve.

Not everyone with heart valve disease needs surgery. If you don't have symptoms or if your heart valve disease is mild, you may just need regular health checkups. Lifestyle changes and medicines also might be recommended.

But if heart valve disease affects your heart's ability to pump blood, you may need surgery.

Sometimes, heart valve surgery may be done even if you don't have symptoms. For example, if you need heart surgery for something else, your surgeon might fix or replace a diseased heart valve at the same time.

Ask your healthcare team whether heart valve surgery is right for you. If you do need valve surgery, ask if minimally invasive heart surgery is possible. Also choose a medical center that has done many heart valve surgeries. This includes both valve repair and valve replacement.

Risks

Possible risks of heart valve surgery are:

• Bleeding.
• Blood clots.
• Infection.
• Irregular heartbeats, called arrhythmias.
• Failure of a replacement valve.
• Heart attack.
• Stroke.

How you prepare

Your healthcare team tells you what to expect before, during and after heart valve surgery and how to prepare. You also learn about the possible risks of the surgery. If you have questions, ask your healthcare team.

Before your surgery, you may have tests to get more details about your heart. For example, you may have an ultrasound of the heart, also called an echocardiogram.

Before you go to the hospital for heart valve surgery, tell your family and caregivers about your hospital stay. Also talk about the type of help you may need when you come home.

Food and medicines

Before you have heart valve surgery, talk to your care team about:

• Allergies. Tell your healthcare team if you've ever had an allergic reaction to any medicines.
• Medicines and supplements. Make sure your healthcare team knows about all the medicines and supplements that you take. Include those bought without a prescription. Your healthcare team tells you if you need to stop any for a while before your surgery.
• Food and drinks. You may be told not to eat or drink for a while before surgery.

Clothing and personal items

Before heart valve surgery, your healthcare team might tell you to bring some items to the hospital, including:

• A list of your medicines.
• Eyeglasses, hearing aids or dentures.
• Personal care items such as a brush, comb, shaving kit and toothbrush.
• Loose, comfortable clothing for after surgery.
• A copy of your advance directive, if you have one. This is a legal document. It has instructions about the kinds of treatments you want or don't want. This helps if you are unable to talk about your care.
• Items that may help you relax such as music players or books.

During heart valve surgery, do not wear:

• Contact lenses.
• Dentures.
• Eyeglasses.
• Jewelry.
• Nail polish.

What you can expect

Heart valve surgery is done at a hospital by a heart surgeon, called a cardiovascular surgeon. To get the best results, the surgery should be done at a medical center with medical teams experienced in doing heart valve surgery.

Before the procedure

Before heart valve surgery starts, a member of your care team may shave any body hair from your chest area. A special soap is used to wash your skin. The soap kills germs and helps prevent infection.

A healthcare team member places a needle in a vein, usually in your arm. The needle has a tube connected to it. This is called an IV. Medicines and fluid go through the IV. You may get medicines to help you relax.

During the procedure

What happens during heart valve surgery depends on the type of surgery being done.

You get medicines to put you in a sleeplike state during heart valve surgery. This is called general anesthesia. You are usually connected to a heart-lung bypass machine. The machine keeps blood moving through your body during surgery.

Heart valve surgery can be done in different ways.

• Open-heart surgery. The surgeon makes a cut, called an incision, through the middle of the chest to reach the heart.
• Minimally invasive heart surgery. This surgery uses much smaller cuts than open-heart surgery. It may mean a shorter hospital stay, less pain, a quicker recovery and fewer complications. An example of minimally invasive heart valve surgery is thoracoscopic surgery or mini-thoracotomy.
• Robot-assisted heart surgery. This is a type of minimally invasive surgery. A surgeon uses robotic arms to do the same movements used in open-heart surgery.
• Catheter treatment. Some heart valve repairs are done using a long, thin tube called a catheter and clips, plugs or other devices. A surgeon can pass tools through the catheter to repair or replace the heart valve.

There are two basic types of heart valve surgery:

• Heart valve repair.
• Heart valve replacement.

Heart valve repair

Heart doctors recommend heart valve repair when possible. It saves the heart valve. It also helps keep the heart working as it used to. Some heart valve repairs also may improve survival when compared with valve replacement. Some heart valve repairs are done using a long, thin tube called a catheter and clips, plugs or other devices. Other times, open-surgery is needed.

During heart valve repair, a surgeon might:

• Patch holes in a valve.
• Rebuild valve flaps, also called leaflets or cusps.
• Remove extra valve tissue so that the valve flaps can close tightly.
• Replace or remove pieces of tissue called cords that are diseased and no longer support the valve.
• Widen a narrowed valve using a thin flexible tube and a tiny balloon. This is called a balloon valvotomy.
• Separate valve flaps that have joined together.
• Tighten or strengthen a ring around the valve, called the annulus.

Heart valve replacement

If your heart valve can't be fixed and other treatments aren't possible, you may need heart valve replacement. A surgeon removes the heart valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue. Valves made from living tissue are called biological tissue valves.

Your healthcare team typically talks with you about the benefits and risks of each type of valve.

• Biological valves can wear out over time. They need to be replaced if this happens.
• Mechanical valves usually do not wear out over time. But if you have a mechanical valve, you need to take blood-thinning medicines for life to prevent blood clots.

Surgeons and other heart doctors can replace some heart valves using thin, flexible tubes called catheters. For example, this type of minimally invasive surgery might be done to put a biological valve in the heart to replace a valve that no longer works.

After the procedure

After heart valve surgery, you usually spend a few days in the hospital. How long you stay in the hospital depends on your specific condition and surgery.

During your hospital stay, your healthcare team frequently checks your breathing, blood pressure and heart rate. Your team also watches for signs of infection. You usually get:

• Oxygen.
• Fluids and medicines, including pain medicine, through an IV.
• Tubes to drain urine from your bladder and fluid and blood from your chest.

While in the hospital, your healthcare team helps you:

• Slowly increase your activity.
• Take longer and longer walks in the hospital.
• Do breathing exercises.

Your care team gives you instructions to follow during recovery, such as:

• How to care for your surgical cuts.
• How to manage pain and other side effects.
• How to know if you have an infection.
• What medicines to take and when.
• When to call your healthcare team.

After heart valve surgery, your healthcare team tells you when you can go back to your usual activities. This includes working, driving, sexual activity and exercise.

Results

You need regular health checkups after heart valve surgery to make sure the valve is working as it should. You also might have tests to check your heart health.

After heart valve surgery, your care team might suggest that you join a program called cardiac rehabilitation. It includes supervised exercise training, emotional support and education about a heart-healthy lifestyle. It's designed just for your specific needs to help you recover after heart surgery.

Lifestyle changes are an important part of recovery after heart valve surgery. Follow these steps to keep your heart healthy:

• Do not smoke and do not use tobacco. Stay away from secondhand smoke.
• Eat healthy foods. Reduce salt and do not eat saturated or trans fats.
• Stay active and exercise.
• Keep a healthy weight. Ask your care team what a good weight is for you.
• Manage stress.
• Manage blood pressure, blood sugar and cholesterol.
• Get 7 to 8 hours of sleep daily.

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