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Heart valve surgery

Overview

Heart valve surgery is a procedure to treat heart valve disease. In heart valve disease, at least one of the four heart valves that keep blood flowing in the correct direction through your heart doesn't function properly.

These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps called leaflets, for the mitral and tricuspid valves, and cusps, for the aortic and pulmonary valves. These flaps open and close once during each heartbeat. Sometimes the valves don't open or close properly, disrupting the blood flow through your heart to your body.

In heart valve surgery, your surgeon repairs or replaces the affected heart valves. Many surgical procedures may be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.

Your treatment depends on several factors, including your age, health, the condition of the heart valve that is affected and the severity of your condition.

Why it's done

Heart valve surgery may be needed if your condition is getting worse, your condition is severe or you're experiencing signs and symptoms of valve dysfunction.

Your doctor may evaluate you to determine the most appropriate treatment for your condition. If you're not experiencing signs or symptoms, or your condition is mild, your doctor may suggest monitoring your condition over time. He or she may recommend healthy lifestyle changes. You may be prescribed medications to manage any symptoms.

However, your valve may eventually need to be repaired or replaced. In some cases, doctors may recommend heart valve repair or replacement even if you're not experiencing symptoms. If you need heart surgery for another condition, doctors may conduct surgery to repair or replace the affected heart valve at the same time.

Your doctor will discuss with you whether heart valve repair or replacement is most appropriate for your condition. Doctors often recommend heart valve repair when possible, as it preserves your heart valve and may preserve heart function. In some cases, you may need heart valve replacement.

Doctors may also evaluate if you're a candidate for minimally invasive heart surgery. Your doctor will discuss the benefits and risks of each procedure.

Heart valve surgery should generally be performed at a medical center with staff that has experience in performing heart valve surgery and that has conducted high volumes of heart valve surgeries.

Risks

Heart valve surgery risks may include:

  • Bleeding
  • Heart attack
  • Infection
  • Valve dysfunction in replacement valve
  • Irregular heart rhythm (arrhythmia)
  • Stroke
  • Death

How you prepare

Before surgery to have your heart valve repaired or replaced, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.

Your doctor and team will discuss with you concerns you may have about your heart valve surgery. Discuss with your doctor and treatment team any questions you may have about the procedure.

You'll need to have your hair shaved at the location of your body where the procedure will take place.

Before being admitted to the hospital for your surgery, talk to your family about your hospital stay and discuss help you may need when you return home. Your doctor and treatment team may give you specific instructions to follow during your recovery when you return home.

Food and medications

Talk to your doctor about:

  • When you can take your regular medications and whether you can take them before your surgery
  • When you should stop eating or drinking the night before the surgery

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital including:

  • A list of your medications
  • Eyeglasses, hearing aids or dentures
  • Personal care items, such as a brush, comb, shaving equipment and toothbrush
  • Loosefitting, comfortable clothing
  • A copy of your advance directive
  • Items that may help you relax, such as portable music players or books

During surgery, avoid wearing:

  • Jewelry
  • Eyeglasses
  • Contact lenses
  • Dentures
  • Nail polish

Precautions regarding medications and allergies

Talk to your doctor about:

  • Any medications you have brought to the hospital and when you should take medications on the day of the procedure
  • Allergies or reactions you have had to medications

What you can expect

If you have heart valve disease, you may eventually need heart valve repair or heart valve replacement to treat your condition. Doctors will discuss with you whether valve repair or replacement is appropriate for your condition.

During the procedure

You'll receive anesthetics, and you may be unconscious during the procedure. You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

Heart valve surgery may be performed during open-heart surgery, which involves a cut (incision) in the chest. Doctors may sometimes perform minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.

Minimally invasive heart surgery includes surgery performed using long instruments inserted through one or more small incisions in the chest (thoracoscopic surgery), surgery performed through a small incision in the chest, or surgery performed by a surgeon using robotic arms (robot-assisted heart surgery).

Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than open-heart surgery. Minimally invasive heart surgery generally should be performed at medical centers with a medical team experienced in performing these types of procedures.

Heart valve repair

Your doctor may often recommend heart valve repair when possible, as it preserves your heart valve and may preserve heart function. Heart valve repair surgery may include:

  • Patching holes in a valve
  • Reconnecting valve flaps (leaflets or cusps)
  • Removing excess valve tissue so that the leaflets or cusps can close tightly
  • Replacing cords that support the valve to repair the structural support
  • Separating valve flaps that have fused
  • Tightening or reinforcing the ring around the valve (annulus)

Some heart valve repair procedures may be performed using a long, thin tube (catheter) and clips, plugs or other devices, but the majority of these remain investigational.

Doctors may treat a valve with a narrowed opening with a catheter procedure called a balloon valvuloplasty. In this procedure, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the affected valve. The balloon is then inflated, which expands the opening of the heart valve. Doctors then deflate the balloon and remove the catheter and balloon.

Heart valve replacement

If your heart valve can't be repaired, your doctor may recommend heart valve replacement. To replace a heart valve, your doctor removes the heart valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Biological valves often eventually need to be replaced, as they degenerate over time. If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots. Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you.

A minimally invasive catheter procedure may be conducted to replace certain heart valves. For example, a catheter procedure may be performed to insert a replacement valve into a biological replacement valve in the heart that is no longer working properly.

After the procedure

After your heart valve surgery, you'll generally spend a day or more in the intensive care unit (ICU). You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may be given oxygen.

After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and surgery.

Your treatment team may monitor your condition and watch for signs of infection in your incision sites. Your team will check your blood pressure, breathing and heart rate. Your treatment team will also work with you to manage pain you may experience after surgery.

Your treatment team will instruct you to walk regularly to gradually increase your activity and to do breathing exercises as you recover.

Your doctor will give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.

Incisions in minimally invasive heart surgery and open-heart surgery

In minimally invasive heart surgery, surgeons access the heart through small cuts (incisions) in the chest, as shown in the top two images. In open-heart surgery, surgeons make a larger incision in the chest, as shown in the bottom image.

Mitral valve repair

In mitral valve repair, a doctor removes the portion of the mitral valve that doesn't close properly, as shown in the top image. Then a doctor sutures together the edges and cinches the circumference of the valve with an annuloplasty band to support the valve, as shown in the bottom image. The illustration shows mitral valve repair using robotic instruments.

Mitral valve repair

In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. The surgeon may tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Mechanical valve replacement

In a mechanical valve replacement, a mechanical valve replaces the damaged valve.

Results

After heart valve surgery, you may be able to return to daily activities, such as working, driving and exercise. Your doctor will discuss with you when you can return to activities. You'll generally still need to take certain medications.

You'll need to attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition.

Your doctor may instruct you to incorporate healthy lifestyle changes — such as physical activity, a healthy diet, stress management and avoiding tobacco use — into your life.

Your doctor may recommend that you participate in cardiac rehabilitation — a program of education and exercise designed to help you improve your health and help you recover after heart surgery.

Last updated: March 23rd, 2018

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