Heart Valve Repair or Replacement Surgery

What is heart valve repair or replacement surgery?

Heart valve repair or replacement surgery is used to fix damaged or diseased heart valves so as to restore heart function. There are 4 valves in your heart that act like doors to control the blood flow between the different parts of the heart.

Normally, these valves open to let blood flow through or out of your heart in one direction. The valves also shut to keep blood from flowing backwards. But sometimes they do not work properly.

Causes of heart valve problems

Heart valve problems can occur due to congenital abnormalities (present at birth), or they can develop later in life as a result of:

• Infections
• Degeneration (wear and tear)
• Other heart conditions

Treatment options

Currently, no medicines can cure heart valve disease. Lifestyle changes and medicines can help to manage symptoms. However, faulty valves will eventually need to be repaired or replaced in order to protect your heart from further damage.

There are 2 approaches to addressing faulty valves:

1. Heart valve repair, which fixes the damaged valve without the use of artificial parts as much as possible.
2. Heart valve replacement, which replaces the malfunctioning valve completely. It is an option if all efforts to repair the abnormal valve fail.

Many surgical approaches can be used to repair or replace heart valves, including open-heart surgery and minimally invasive surgery. Your treatment options will depend on several factors, such as your age, health, the condition of the affected heart valve and the severity of your condition.

Why do you need heart valve repair or replacement surgery?

Heart valve repair or replacement surgery aims to restore heart function by repairing or replacing a faulty valve. It may be used to treat the following heart valve problems:

• Regurgitation or 'leaking' heart valves, which occurs when the heart valves do not close fully, allowing blood to leak backwards into the chambers of the heart.
• Stenosis, which occurs when the valve thickens, stiffens or fuses together. As a result, the heart has to work harder to pump blood through the valve, and the body may suffer from a reduced supply of oxygen.
• Atresia, a condition where the heart valve lacks an opening for blood to pass through. It can occur as a congenital disease, prior to birth, or develop later in life. Congenital atresia may affect the pulmonary valve (found in the right lower chamber of the heart) or aortic valves (found in the left lower chamber of the heart). Valve problems that develop later usually involve the aortic or mitral valves. Atresia can cause stenosis or regurgitation.

The decision to repair or replace your heart valve will depend on your symptoms and test results. The benefits of a successful heart valve repair surgery are:

• Decrease in the risk of stroke
• Decrease in the risk of infection
• Reduction in the need for blood thinners
• Conservation of the heart muscle's strength
• Increase in the chances of long-term survival

If left untreated, advanced valve disease can lead to serious, life-threatening complications. For example, abnormal functioning of the aortic valve can lead to heart failure because of reduced blood supply to the heart muscle.

What are the risks and complications of heart valve repair or replacement surgery?

As with any surgery, there will be some risks involved, depending on your specific medical condition.

Be sure to discuss any concerns with your healthcare provider before the procedure.

How do you prepare for heart valve repair or replacement surgery?

Before recommending valve surgery, your doctor will review your medical history, allergies and medications.

You may need to:

• Fast before the procedure.
• Adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).
• Quit smoking for at least 8 weeks before your surgery.

Once your surgery is scheduled, your doctor will advise you further on how to prepare.

What can you expect in heart valve repair or replacement surgery?

There are 2 types of heart valve repair or replacement surgery:

1. Open-heart surgery. During open-heart surgery, you will be placed under general anaesthesia. A heart-lung bypass machine will be used to keep the blood moving.
2. Minimally invasive surgery. During minimally invasive surgery, your surgeon will make small incisions to insert the surgical instruments. Minimally invasive procedures usually mean a shorter hospital stay and faster recovery time.

Estimated duration

The procedure takes about 2 – 4 hours.

During the procedure

Depending on the type of valve condition you have, your doctor may repair the valve by:

• Patching the holes in a valve
• Separating fused valve flaps
• Reconnecting valve flaps
• Removing excess valve tissue
• Replacing cords that support the valve
• Tightening or reinforcing the ring around the valve

If efforts to repair the malfunctioning valve fail, your surgeon may replace the existing valve using:

• Artificial valves made of plastic or metal
• Bioprosthetic valves made of biological material from animal tissue
• Allograft valves made from human valve tissue

After the procedure

After the surgery, you will spend some time in the intensive care unit (ICU) for observation. You will be monitored for infection, heart activity, blood pressure and breathing.

Fluids and medications will be administered intravenously. Tubes will drain urine from your bladder and fluids from your chest.

Before your discharge, you will be advised on proper care of the incisions, monitoring for infection, pain relief and medication.

Care and recovery after heart valve repair or replacement surgery

Recovering from valve surgery usually takes 1 – 2 months. If you had minimally invasive surgery, your recovery time may be shorter.

You will need to attend follow-up appointments so that your doctor can monitor your recovery and advise when you can return to your daily activities.