What is heart valve surgery?

Dr. David H. Adams, MD
Cardiothoracic Surgeon

Heart valve surgery is used to repair or replace any of the four valves in the heart if they are tight (stenosis) or leaky (regurgitation).

Mitral valve repair is the most effective treatment for mitral valve regurgitation. It is the only treatment shown to restore life-expectancy to normal. Your surgeon will restore the structure supporting the valve leaflets to its normal size and shape usually using a manufactured ring, and use a variety of techniques to make sure enough leaflet meets in the middle of the valve to make it watertight again. The quality of the repair is tested by injecting saline into the heart and seeing whether any leaks back through the valve. Mitral stenosis is usually treated by replacing the valve with a manufactured valve.

The most effective treatment for aortic stenosis is aortic valve replacement. Aortic regurgitation can sometimes be treated by valve repair, but usually involves valve replacement.

The heart has four different valves: the tricuspid, the mitral, the pulmonary and the aortic valve. A heart valve surgery is usually done on the aortic, the mitral and the tricuspid valve when one or more of these becomes incompetent or stenotic. The aortic valve is replaced with a mechanical or biologic valve. The mitral valve can be repaired (most commonly) or replaced by a mechanical or biologic one and the tricuspid valve is usually repaired. There are different repair techniques and replacement valves. The biologic valves are taken from pigs and cows or made from human tissue or bovine pericardium and the mechanical ones are made from artificial long-lasting materials. The surgery is an open-heart under general anesthesia requiring the use of a heart-lung machine which replaces the function of the heart and the lungs while the surgeon fixes or replaces the valve. Recently there is an option for minimally-invasive heart valve surgery which by half-cutting the breastbone or using thoracic access reduces the pain from incision, the blood loss and the length of stay to the hospital with patients having a better cosmetic result.

Like any pump or engine, the heart has valves which maintain flow in the appropriate direction. Abnormalities of the valves can be present from birth (congenital valve disease) or may develop later in life (acquired valve disease). Typically, the abnormal valve is narrowed (stenosis), leaking (regurgitation or insufficiency), or both. Heart valve disease is sometimes treated medically, but surgery may be required. Heart valve surgery, unlike coronary bypass, is truly open heart surgery. The heart lung machine is used to support the circulation while one or more chambers of the heart is opened to gain access to the valve. The operation allows the surgeon to either repair the valve, maintaining most of its normal tissue, or replace it with an artificial valve. The skin incision can be the traditional approach through the front of the chest, called a median sternotomy, but technology is now available to allow minimally invasive surgery through smaller incisions or port sites in selected cases. If someone has both valve disease and coronary artery disease, the valve surgery and coronary bypass may be performed together.

Dr. William D. Knopf, MD
Cardiologist (Heart Specialist)

Heart valve surgery can also be called open heart surgery and this type of surgery occurs when patients have valve problems that are either restricting blood flow or incompetent. Valve surgery means that the heart valve needs to be either repaired or replaced. Heart valve surgery can occur at any time within our life, and heart valve surgery usually, but not always, requires a heart lung machine or bypass machine in order for blood to be diverted away from the heart to allow the surgeon to do the repair that he needs to do.

Heart valve surgery involves working and repairing or replacing the heart valve of a patient. There are four heart valves in the heart, called the aortic valve, mitral valve, tricuspid valve and the pulmonary valve. Primarily the aortic valve and the mitral valve are the ones that give us trouble. They can either leak or they can narrow down or become "stenotic." The surgeon may choose to open up the heart and try to repair the valve either with open heart surgery or limited invasive surgery through robotic or portal surgery. If the surgeon cannot repair the valve, which is the best alternative, then the valve may be replaced either with an artificial valve from animal material or a mechanical valve. Mechanical valves are very durable but require blood thinners such as Coumadin. The future of valve surgery may include percutaneous valve repair or replacement, where doctors can place a new valve in the heart or repair the old one using a catheter inside the arteries and veins of the patient without having to cut their chest open. This is a new and exciting development. Stay tuned.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.