Aortic and Mitral Valve Repair or Replacement
For the heart to work well, blood must flow in only one direction. The heart’s valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward.
Heart surgery is used to fix leaflets that don’t open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve.
Heart surgery also is used to fix leaflets that don’t close tightly. This problem can cause blood to leak back into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well.
To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that’s too narrow, a cardiologist (heart specialist) will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart.
The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery.
Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place.
Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart.
In some cases, surgeons might make a small cut in the chest and left ventricle (the lower left heart chamber). They will thread the catheter into the heart through the small opening.
The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve.
Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
- Preventing, treating, or relieving the symptoms of other related heart conditions.
- Protecting heart valves from further damage.
- Repairing or replacing faulty valves when they cause severe symptoms or become life threatening. Replacement valves can be man-made or biological.
Preventing, Treating, or Relieving the Symptoms of Other Related Heart Conditions
To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute’s “Your Guide to Lowering Your Blood Pressure With DASH” and the U.S. Department of Agriculture’s ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn’t leave you unusually short of breath or tired.
Your doctor may prescribe medicines to:
- Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
- Lower high blood pressure or high blood cholesterol.
- Treat coronary heart disease (CHD). CHD medicines can reduce your heart’s workload and relieve symptoms.
- Prevent arrhythmias (irregular heartbeats).
- Thin the blood and prevent clots (if you have a man-made replacement valve). These medicines also are prescribed for mitral stenosis or other valve defects that raise the risk of blood clots.
Protecting Heart Valves From Further Damage
If you’ve had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.
One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you’ve had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Repairing or Replacing Heart Valves
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn’t causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on many factors, including:
- The severity of your valve disease.
- Your age and general health.
- Whether you need heart surgery for other conditions, such as bypass surgery to treat CHD. Bypass surgery and valve surgery can be done at the same time.
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don’t need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
Repairing Heart Valves
Heart surgeons can repair heart valves by:
- Separating fused valve flaps
- Removing or reshaping tissue so the valve can close tighter
- Adding tissue to patch holes or tears or to increase the support at the base of the valve
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.
Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.
Balloon valvuloplasty. Heart valves that don’t fully open (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy (val-VOT-o-me).
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.
You’re awake during the procedure, which usually requires an overnight stay in a hospital.
Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. Thus, for these people, balloon valvuloplasty often is preferred over surgical repair or replacement.
Balloon valvuloplasty doesn’t work as well as surgery for adults who have aortic valve stenosis.
Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.
Replacing Heart Valves
Sometimes heart valves can’t be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won’t need medicines to stop your body from rejecting the valve.
Man-made valves last longer than biological valves and usually don’t have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer.
Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of IE.
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
If you’re a woman of childbearing age or if you’re athletic, you may prefer a biological valve so you don’t have to take blood-thinning medicines. If you’re elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
Other Approaches for Repairing and Replacing Heart Valves
Some newer forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3–5 days, compared with 5-day stays for traditional heart valve surgery.
New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2–4 weeks versus 6–8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring catheter procedures that involve threading clips or other devices through blood vessels to faulty heart valves. The clips or devices are used to reshape the valves and stop the backflow of blood.
People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery. Researchers are still studying this treatment method.
Doctor also may use catheters to replace faulty aortic valves. This procedure is called transcatheter aortic valve implantation (TAVI).
For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. At the end of the catheter is a deflated balloon with a folded replacement valve around it.
Once the replacement valve is properly placed, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.
A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.
Catheter procedures may be an option for patients who have conditions that make open-heart surgery too risky. Only a few medical centers have experience with these fairly new procedures.
Doctors also treat faulty aortic valves with a procedure called the Ross operation. During this operation, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. Your pulmonary valve is then replaced with a pulmonary valve from a deceased human donor.
This is more involved surgery than typical valve replacement, and it has a greater risk of complications.
The Ross operation may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isn’t required.
But in some patients, one or both valves fail to work well within a few years of the surgery. Experts continue to debate and study the usefulness of this procedure.
Serious risks from all types of heart valve surgery vary according to your age, health, the type of valve defect(s) you have, and the surgical procedures used.
Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.