Mayo Clinic heart (cardiac) surgeons perform heart valve surgery to treat many types of heart valve disease. Your surgeon can perform many procedures using minimally invasive heart surgery, using smaller incisions than in open-heart surgery.
Your treatment depends on several factors, including your age, your general health, the condition of your heart valves and your preference. A team of heart specialists (cardiologists), heart surgeons and other specialists work with you to determine the appropriate surgery to treat your condition.
Heart valve repair
Heart valve specialists and surgeons agree that whenever possible, a heart valve should be repaired rather than replaced. Heart valve repair leaves you with your normally functioning tissue, and you may not need to take lifelong blood-thinning medications.
Repair may be possible if you have a problem with your mitral valve not closing properly (regurgitation). There are three mechanisms by which your surgeon may repair the valve. Your surgeon may use one of more of these procedures.
- Annuloplasty. In this procedure, your surgeon tightens the tissue around the valve by implanting an artificial ring. This allows the leaflets to come together and close the abnormal opening through the valve.
- Repair of structural support. In this procedure, your surgeon replaces or shortens the cords that support the valves (chordae tendineae and papillary muscles) to repair the structural support. When the cords and muscles are the right length, the valve leaflet edges meet and eliminate the leak.
- Valve leaflet repair. In valve leaflet repair, your surgeon surgically separates, cuts or pleats a valve flap (leaflet).
Heart valve replacement
If your heart valve can't be repaired, your surgeon will remove your damaged valve and replace it with an artificial (prosthetic) valve. You may need heart valve replacement if you have valve narrowing (stenosis) or severely damaged valves affected by calcium buildup in the valves (calcification) or rheumatic disease.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic stenosis). TAVR is typically reserved for people who can't undergo open-heart surgery or for people for whom surgery presents too many risks. TAVR is sometimes called transcatheter aortic valve implantation (TAVI).
Surgeons perform procedures often to replace mitral or aortic valves, but your surgeon can replace any heart valve.
Types of heart valve replacements include:
- Mechanical valves. Mechanical valves are made of synthetic materials, which are designed to last many years. However, blood tends to stick to mechanical valves and create blood clots. If you have a mechanical valve, you'll need to take blood-thinning medicines (anticoagulants) for life.
Biological valves. Biological valves, or tissue valves, are made from animal tissue (xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, your own tissue can be used for valve replacement (known as an autograft, or Ross, procedure).
If you have a biological valve, you may not need to take lifelong blood-thinning medication. However, biological valves aren't as durable as mechanical valves, and they eventually may need to be replaced. Surgeons most often use biological valves in older adults.
See a video on mitral valve repair.
Mar. 21, 2014
Watch Mayo Clinic cardiothoracic surgeon Rakesh M. Suri, M.D., D.Phil, discuss robotic heart surgery.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Aug. 20, 2013.
- Antman EM, et al. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Aug. 20, 2013.
- Suri RM, et al. Quality of life after early mitral valve repair using conventional and robotic approaches. The Annals of Thoracic Surgery. 2012;93:761.
- Nishimura RA (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 23, 2013.