Heart Valve Surgery

There are four valves in your heart. Each valve makes sure blood flows through the heart in the correct way. When there’s an issue with one or more of the valves, surgery is an option to fix them. 

What are the heart valves?

Your heart is made up of four connected chambers (or sections) that take in and pump out blood. For each chamber, there is a valve with small flaps of skin that open and close to let blood through in the right direction. These are the:

• aortic valve 
• mitral valve 
• pulmonary valve 
• tricuspid valve

Why is heart valve surgery done?

Heart valve surgery is done when one or more of your valves is diseased or damaged. If you have one of these issues, it can affect how your blood flows through your heart in two ways:

• if your valve doesn’t open fully or becomes stiff, it will block the flow of blood. This is called valve stenosis or narrowing
• if the valve doesn’t close properly, it will allow blood to leak backwards. This is called valve incompetence, regurgitation, or a leaky valve.

Both stenosis and regurgitation can put extra strain on your heart because your heart must pump harder to push the blood through the valves. Symptoms of these issues include:

• chest pain
• dizziness and fainting
• palpitations (a pounding or fluttering in the chest)
• shortness of breath
• swelling of your ankles and legs
• tiredness.

You can discuss all of your treatment options with your doctor so you make the best decision. If you have little or mild symptoms, your doctor might prefer to see if things improve with healthy lifestyle changes and medication.

What are the heart valve surgery treatment options?

Many people with heart valve disease need little or no treatment. However, your cardiologist will check to see if you’re suitable for surgery based on your condition. Surgery might be the best option if it’ll improve your symptoms and quality of life by a long way.

If your doctor believes surgery is the best option, you will get a valve repair or a valve replacement.

• valve repair is used for valves that become floppy and leak but aren’t seriously damaged. If it’s possible to repair the valve, your surgeon may do this rather than replace it
• valve replacement is when the old valve is replaced with a new valve. The most common types of replacement valves are mechanical (artificial) valves or tissue (animal) valves.

In some cases, a Transcatheter aortic valve implantation (TAVI) procedure may be used if you’re an adult and not well enough to have traditional heart surgery. This is a less invasive way of performing valve surgery and is a newer treatment option. Speak with your surgeon about the advantages and disadvantages of this type of surgery as it’s not suitable for everyone.

Whether or not you have heart valve surgery, and whether the operation is a repair or a replacement will depend on many things. These include the cause of the problem, which valve is affected, how badly the valve is affected, how many valves are affected, your symptoms, and your general health. 

What are mechanical and tissue valves?

When replacing a valve, your surgeon will remove your faulty valve and sew in a new one. There are two options for a new valve:

• mechanical (artificial) – valves made of mechanical parts. These valves last a long time and are usually recommended to younger patients. However, blood clots can form more easily so anticoagulants like warfarin must be taken for the rest of your life
• tissue (animal) – valves mostly made of tissue taken from humans, pigs or cows. These are safe to insert, last from 15 to 20 years, and mean you won’t have to take anticoagulants (blood thinning medications) for the rest of your life.

How long will I recover after heart valve surgery?

You’ll usually be helped to sit out of bed the day after the procedure. You can expect some discomfort after your operation and you will be offered pain relief medication. Your pain level will be watched to make sure you’re as comfortable as possible. Many people return home within a week but recovery time depends on the type of surgery you have and how your body reacts.

On average, it takes between 2-3 months to fully recover, but this can vary as everyone responds differently to treatment.

What are the advantages of heart valve surgery?

For most people, heart valve surgery helps:

• give you more energy so everyday tasks and physical activities become easier and more enjoyable
• improve mood and mental health due to reduced symptoms
• increase life expectancy
• reduce symptoms like shortness of breath, blackouts, tiredness, chest pain and fluid retention
• reduce the risk of your heart failure developing further.

What are the risks of heart valve surgery? 

Like all operations, valve surgery isn’t risk free. Your risk depends on your age, your current state of health and the level of your valve disease. Common risks include:

• atrial fibrillation (an abnormal heart rhythm) after surgery. This usually gets better with treatment
• bleeding – you may need a further operation after surgery to control bleeding
• death – the risk of not surviving the operation will be higher if you’re very unwell before the surgery. You can discuss this with your surgeon at your consultation
• renal (kidney) failure – this is more common if you already have kidney problems and can be treated with dialysis.
• stroke – this happens when a blood clot develops and travels to the brain, cutting off the oxygen supply. The risk is higher if you have had a stroke or transient ischaemic attacks (TIAs, commonly known as mini-strokes). To reduce the risk of stroke, you’ll be given medications during and after the operation. You may have to wear special stockings after your operation which can help reduce the risk of clots
• wound infection – this is more common if you have poorly controlled diabetes or other conditions that mean you’re more at risk of infection. If you do get an infection, this can be treated with antibiotics.

Talk to your surgeon before the procedure and ask any questions you may have about both the benefits and risks of the operation. 

If you have a heart valve problem or have had surgery on your valve, you’re at risk of endocarditis. You’re also at risk if you have had endocarditis before. Endocarditis is inflammation of the inner lining of your heart (endocardium) caused by bacteria that enters your bloodstream and finds its way to the heart, including the valves and the endocardium.