Heart Valves

When one (or more) valve(s) becomes stenotic (stiff), the heart has to work harder to pump the blood through the valve. Valves can become narrow and stiff from infection (such as rheumatic fever or staph) and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your healthcare provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.

Traditionally, open-heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve(s). Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays.

The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be made of carbon coated plastic or tissue (made from animal valves or human valves taken from donors). You and your healthcare provider will talk about the pros and cons of each type and what might be best for you.

Why might I need heart valve repair or replacement surgery?

Valve repair or replacement surgery is done to correct the problems caused by one or more diseased heart valves.

If your heart valve(s) becomes damaged or diseased, you may have the following symptoms:

• Dizziness
• Chest pain
• Breathing difficulties
• Palpitations
• Edema (swelling) of the feet, ankles, or abdomen (belly)
• Rapid weight gain due to fluid retention

There may be other reasons for your healthcare provider to recommend heart valve repair or replacement surgery.

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

Possible risks of heart valve repair or replacement surgery include:

• Bleeding during or after the surgery
• Blood clots that can cause heart attack, stroke, or lung problems
• Infection
• Pneumonia
• Pancreatitis
• Breathing problems
• Arrhythmias (abnormal heart rhythms)
• The repaired or replaced valve doesn’t work correctly
• Death

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for heart valve repair or replacement surgery?

• Your healthcare provider will explain the procedure and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is unclear.
• Along with a complete medical history, your healthcare provider may do a complete physical exam to make sure that you are in otherwise good health before surgery. You may need blood tests or other diagnostic tests.
• You will be asked to fast (not eat or drink) for 8 hours before the procedure, generally after midnight.
• If you are pregnant or think you could be, tell your healthcare provider.
• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).
• Be sure your healthcare provider knows about all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicine, aspirin, or other medicines that affect blood clotting. You may be told to stop some of these medicines before surgery.
• Your healthcare provider may do a blood test before surgery to see how long it takes your blood to clot.
• Tell your healthcare provider if you have a pacemaker or any other implanted cardiac devices.
• If you smoke, stop smoking as soon as possible. This improves your chances for a successful recovery from surgery and benefits your overall health status.
• Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during heart valve repair or replacement surgery?

Heart valve repair or replacement surgery requires a stay in a hospital. Procedures may vary depending on your condition and your healthcare providers practice.

Generally, open-heart valve repair or replacement follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
2. You will change into a hospital gown and empty your bladder.
3. The surgical team will position you on the operating table, lying on your back.
4. A healthcare professional will start an intravenous (IV) line in your arm or hand for injection of medicine and to give IV fluids. More catheters will be put in blood vessels your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples.
5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
6. Your doctor will put a breathing tube through your mouth into your lungs and connect you to a ventilator, a machine that will breathe for you during the surgery.
7. Your doctor will place a transesophageal echocardiogram (TEE) probe into your esophagus (swallowing tube) so he or she can monitor the function of the valves.
8. A soft, flexible tube (called a Foley catheter) will be put into your bladder to drain urine.
9. A tube will be put through your mouth or nose into your stomach to drain stomach fluids.
10. Someone on the surgical team will clean the skin over your chest with an antiseptic solution. If there is a lot of hair at the surgical site, it may be shaved off.
11. If you are having an open-heart surgery, your healthcare provider will make an incision (cut) down the center of the chest from just below the Adam’s apple to just above the navel. If you are having a less invasive procedure it may require smaller incisions.
12. The sternum (breastbone) will be cut in half lengthwise. The healthcare provider will separates the halves of the breastbone and spread them apart to expose your heart.
13. To do the valve repair or replacement, your doctor must stop your heart. He or she will put tubes into the heart so that the blood can be pumped through your body by a heart-lung bypass machine while your heart is stopped.
14. Once the blood has been completely diverted into the bypass machine for pumping, your doctor will stop your heart by injecting it with a cold solution.
15. When the heart has stopped, your doctor will remove the diseased valve and put in the artificial valve, in the case of a valve replacement. For a valve repair, the procedure done will depend on the type of valve problem you have, for example, your doctor may separate fused valve leaflets, repair torn leaflets, or reshape valve parts to ensure better function.
16. Once the surgery is done, your doctor will shock your heart with small paddles to restart your heartbeat. Next, he or she will allow blood circulating through the bypass machine to re-enter your heart and remove the tubes to the machine.
17. Once your heart is beating again, your doctor will watch it to see how well the heart and valves are working and be sure that there are no leaks from the surgery.
18. Your doctor may put wires for pacing into your heart. He or she can attach these wires to a pacemaker outside your body for a short time and your heart can be paced, if needed, during the initial recovery period.
19. Your doctor will rejoin the sternum sewing it together with small wires (like those sometimes used to repair a broken bone).
20. Your doctor will put tubes into your chest to drain blood and other fluids from around the heart.
21. Your doctor will sew the skin over the sternum back together and close the incision with sutures or surgical staples.
22. A member of the surgical team will apply a sterile bandage or dressing.

What happens after heart valve repair or replacement surgery?