Valve Replacement

Valvular heart disease is a form of heart disease that occurs when one or more of the heart’s four valves don’t function properly. Valve replacement surgery is a solution for patients whose valves are too fragile, scarred, or otherwise damaged to repair.

Reasons for Replacement

The valves of the heart are responsible for allowing nutrient-rich blood to flow to the chambers of your heart. Like a locked gate, each valve is supposed to close completely after ushering in the blood flow. Diseased heart valves aren’t always able to perform the job as well as they should.

Stenosis, or a narrowing of the passageway, causes a less-than-normal amount of blood to flow to the heart, causing the muscle to work harder. Leaky valves can also pose a problem. Instead of closing tightly, a valve may remain slightly open, letting blood flow backwards. Signs of valvular heart disease can include:

  • fatigue
  • dizziness or lightheadedness
  • shortness of breath
  • chest pain
  • fluid retention, especially in the lower limbs

Heart valve repair is also a solution for valve disease, but in some people, the damage is too far advanced and a total replacement of the affected valve is required.

Types of Replacement Valves

Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that fulfill the same job as a natural heart valve. They’re created from carbon and polyester materials that are well-tolerated by the human body, and can last between 10 and 20 years, according to the National Institutes of Health (NIH). However, one of the risks associated with mechanical valves is blood clots. Recipients of mechanical heart valves are required to take blood-thinning medication for the rest of their lives to reduce their risk of stroke.

Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. Three types of biologic heart valves exist:

  • human: called allografts or homografts, tissue is taken from a donor heart
  • porcine: made from pig tissue, the valves can be implanted with or without a frame called a stent
  • bovine: crafted from cow tissue, bovine valves connect to your heart with silicone rubber

Biologic valves don’t increase your risk of developing blood clots. Therefore, you most likely won’t need to commit to a lifetime of anti-clotting medication. The lifespan of a bioprosthetic isn’t as long as a mechanical valve, explains the Mayo Clinic, and may require replacement at a future date.

Your age, overall health, age, and ability to take anti-coagulant medications, as well as the extent of the disease, will help determine which type of valve you receive.

Types of Valve Replacement Surgery

Aortic Valve Replacement

The aortic valve is located on the left side of the heart and serves as an outflow valve. Its job is to allow blood to leave the left ventricle (the heart’s main pumping chamber) and close so that blood doesn’t leak back into the ventricle. Surgery on the aortic valve may be required due to a congenital (from birth) defect or disease that causes the valve to narrow (stenosis) or leak (regurgitation).

The most common type of congenital abnormality is a bicuspid valve. Normally, the aortic valve has three sections of tissue (leaflets). This is called a tricuspid valve. A defective valve has only two leaflets (bicuspid). Aortic valve replacement surgery has about a 98 percent survival rate. Survival rates depend on your age, overall health, other medical conditions, and heart function.

Mitral Valve Replacement

The mitral valve is located on the left side of the heart. It serves as an inflow valve. Its job is to allow blood from the left atrium to flow into the heart’s main pumping chamber, the left ventricle. Surgery may be required if the valve doesn’t fully open or completely close. When the valve is too narrow, blood may have difficulty entering and can back up, causing pressure in the lungs. When the valve doesn’t close properly, blood can leak back into the lungs. This can be due to a congenital defect, infection, or a degenerative disease (a worsening over time due to age or normal wear and tear).

The defective valve will be replaced with either a metal artificial valve or a tissue valve. The metal valve will last a lifetime but requires the patient to take blood thinners. The tissue valve lasts between 15 to 20 years and the patient doesn’t require blood thinning medication. Surgery survival rate is about 94 percent and depends on your age, overall health, other medical conditions, and heart function. Ask your doctor to help assess your personal risks.

Double Valve Replacement

Double valve replacement is replacement of both the mitral and the aortic valve, or the left side of the heart. This type of surgery is not as common as the others and the mortality rate is slightly higher. 

Pulmonary Valve Replacement

The pulmonary valve separates the pulmonary artery—which carries blood to the lungs for oxidation—and the right ventricle (one of the heart’s chambers). Its job is to allow blood to flow from the heart to the lungs, via the pulmonary artery. The need for pulmonary valve replacement is usually due to stenosis, which restricts blood flow. Stenosis may be caused by a congenital defect, infection, or carcinoid syndrome.     

The Procedure

Heart valve replacement surgery is performed under general anesthesia with techniques that are either conventional or minimally invasive. Conventional surgery requires a large incision spanning from your neck to your navel. Less invasive measures can reduce the length of incision and also reduce your risk of infection.

For a surgeon to successfully remove the diseased valve and replace it with a new one, your heart must be still. You’ll be placed on a bypass machine that keeps blood circulating through your body and your lungs functioning during surgery. The surgeon will make incisions into your aorta, through which the valves will be removed and replaced. Cleveland Clinic reports a 1.8 percent risk of death associated with valve replacement surgery.

Recovery

The majority of heart valve replacement recipients remain in the hospital for approximately five to seven days. If your surgery was minimally invasive, you may be able to go home earlier. Medical staff will offer pain medication as needed and continuously monitor your blood pressure, breathing, and heart function during the first few days after a heart valve replacement.

Full recovery may take a few weeks or up to several months, depending on your rate of healing and the type of surgery that was performed. Infection is the primary risk directly after surgery, so keeping your incisions sterile is of utmost importance. Always contact your physician right away if you experience symptoms that indicate infection, such as:

  • fever
  • chills
  • tenderness or swelling at incision site
  • increased drainage from the wounds

Follow-up appointments are important and will help your doctor determine when you’re ready to resume your everyday activities. Assemble a post-valve replacement support system. Enlist family members and friends to help you out around the house and drive you to doctor appointments as you recover.