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Heart Valve Replacement

By

Sarah Lewis, PharmD

What is a heart valve replacement?

A heart valve replacement removes a diseased or damaged heart valve and replaces it with a new heart valve. Heart valves keep blood flowing in one direction through the four chambers of your heart. They open to allow blood to flow forward to the body. They then close tightly so blood does not leak backwards into the heart. Diseased or damaged heart valves can cause a backflow of blood or not allow blood to flow forward normally. 

Heart valve replacement is a major surgery with significant risks and potential complications. You may have less invasive treatment options, such as a heart valve repair procedure. Consider getting a second opinion about all your treatment options before having a heart valve replacement. 

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Types of replacement heart valves

The new valve used in a heart valve replacement is called a prosthesis. The types of heart valve prostheses include:

  • Animal valve prostheses, also called biological or tissue valves, come from either pigs (porcine) or cows (bovine). Tissue valves may also have some man-made parts attached to them. Tissue valves may last 10 to 15 years before they need replacement. These valves do not require taking blood thinners for the rest of your life.

  • Human valve prostheses come from human donor hearts. These valves are also called biological or tissue valves. They may also have some man-made parts attached to them and may last 10 to 15 years before they need replacement. These valves do not require taking blood thinners for the rest of your life.

  • Mechanical valve prostheses are man-made valves, created from a form of carbon. Mechanical valves are generally more durable than tissues valves. Mechanical valves generally last more  than 15 years. However, you must take blood-thinning medication for the rest of your life if you have a mechanical valve. 

Other surgical procedures that may be performed

Your doctor may also perform other procedures in addition to a heart valve replacement. These include:

Coronary artery bypass graft (CABG, heart bypass surgery) uses a graft to make a new route for blood to flow around blocked coronary arteries in the heart. Grafts are made with healthy vessels taken from other places in the body.

Percutaneous coronary intervention (angioplasty) involves widening or opening a blocked or narrowed coronary arteries in the heart. A stent is typically placed in the artery to keep it open longer.

Why is a heart valve replacement performed? 

A heart valve replacement is a major surgery that your doctor may recommend when one or more of your heart valves does not open or close correctly. A heart valve that does not close all the way leads to regurgitation. Regurgitation lets blood flow backward instead of forward.

A heart valve that does not open all the way is called stenosis. Stenosis is a narrowing of the valve opening. It prevents blood from flowing forward effectively. 

Your doctor may consider a heart valve replacement for you if your heart valve disease causes serious symptoms. These include fatigue, dizziness, passing out, shortness of breath, and swelling of the ankles. It is often preferable to repair instead of replace the valve if possible. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a heart valve replacement. 

Your doctor may recommend a heart valve replacement to treat:

  • Aortic regurgitation or stenosis. The aortic valve opens to allow blood to leave the heart and closes to prevent blood from flowing back into the heart. 

  • Congenital heart valve disease, a condition that is present at birth

  • Mitral valve regurgitation or stenosis. The mitral valve opens to allow blood to leave the left atrium and enter the left ventricle. It closes to prevent blood from flowing back into the left atrium.

  • Prosthesis replacement when a previous valve replacement is no longer working or is causing problems

  • Pulmonary valve regurgitation or stenosis. The pulmonary valve opens to allow blood to leave the heart and go to the lungs to pick up oxygen. It closes to prevent blood from flowing back into the heart.

  • Tricuspid valve regurgitation or stenosis. The tricuspid valve opens to allow blood to leave the right atrium and enter the right ventricle. It closes to prevent blood from flowing back into the right atrium.

Who performs a heart valve replacement?

A cardiac surgeon performs a heart valve replacement. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon.

A subspecialist called a congenital cardiac surgeon may perform the surgery on a heart valve with a congenital defect (a defect present at birth).

How is a heart valve replacement performed?

Your heart valve replacement  will be performed in a hospital using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an endoscope through a three to four inch incision in the chest. The endoscope is a small, thin camera that sends pictures of the inside of your body to a video screen. Your surgeon views the surgical area on the video screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a large one used in open surgery. Surgical tools are threaded around structures, such as the breastbone and muscles, instead of cutting through or displacing them as in open heart surgery. Minimally invasive surgery may also include the use of a surgical robot or special imaging technologies (computer-assisted surgery) to help your surgeon view the area and perform the surgery.

  • Open heart surgery involves making a six to eight inch incision in chest through the breastbone (sternum). Open surgery allows your surgeon to view and access the heart directly. Open heart surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open heart surgery may be a safer or more effective method for certain patients.

  • Catheter surgery may be an option for patients who are not candidates for other types of valve replacement surgeries. Catheter surgery involves inserting a catheter (a long, thin tube) through a blood vessel in your groin. Your surgeon will thread the catheter up and into the heart until it reaches the diseased valve. The catheter tip contains a deflated replacement valve that expands once the catheter is in place. This type of heart valve replacement is an emerging technology that is only available at certain medical centers.

Surgeons sometimes combine minimally invasive techniques with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you require an open surgery to safely and effectively complete your surgery. 
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different heart valve repair procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform your heart valve replacement using either general or regional anesthesia, depending on the specific procedure. General anesthesia is more common for these procedures.

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your heart valve replacement

You will be admitted to the hospital the day before your heart valve replacement surgery. For minimally invasive procedures, you will probably report to the hospital the morning of your surgery. The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or