For the heart to work right, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from the heart chambers into the arteries. Then the leaflets close tightly to stop blood from flowing back into the chambers.
Heart surgery is done to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve into the artery.
Heart surgery also is done to fix leaflets that don't close tightly. If the leaflets don't close tightly, blood can leak backward into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it. Replacement valves are taken from animals or made from human tissue or man-made materials.
To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a surgeon will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart. This procedure is called cardiac catheterization (KATH-e-ter-i-ZA-shun).
The surgeon will place the end of the catheter inside the narrowed valve. He or she will rapidly inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing blood to flow through it to the artery. This approach is less invasive than open-heart surgery.
Repairing or Replacing Heart Valves
Your doctor may recommend repairing or replacing your heart valve(s), even if you do not yet have symptoms of heart valve disease. This can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on a number of factors, including:
- How severe your valve disease is.
- Your age and general health.
- Whether you need heart surgery for other conditions, such as bypass surgery to treat CHD. Bypass surgery and valve surgery can be done at the same time.
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement.
Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
Repairing Heart Valves
Heart valves can be repaired by:
- Separating fused valve flaps
- Removing or reshaping tissue so the valve can close tighter
- Adding tissue to patch holes or tears or to increase the support at the base of the valve
Heart surgeons do most heart valve repair surgeries. Cardiologists do some repair surgeries using cardiac catheterization. Although catheterization procedures are less invasive, they also may not work as well for some patients.
You and your doctor will decide whether repair is appropriate and what the best procedure is for doing it.
Balloon valvuloplasty. Heart valves that don't open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy (val-VOT-o-me).
During the procedure, a balloon-tipped tube is threaded through your blood vessels and into the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.
You're awake during the procedure, which usually requires an overnight stay in the hospital.
Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can still worsen over time. You may need medicines to help with symptoms or surgery to repair or replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery. For some patients who have mitral valve stenosis, it may work as well as surgical repair or replacement. For these reasons, balloon valvuloplasty usually is preferred over surgical repair or replacement for these people.
Balloon valvuloplasty doesn't work as well as surgical treatment for adults who have aortic valve stenosis.
Balloon valvuloplasty often is used in infants and children. In these patients, congenital defects cause valve stenosis. Doctors can repair the defects using balloon valvuloplasty.
Replacing Heart Valves
Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or a biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have parts as well. These valves are specially treated, so no medicines are needed to stop the body from rejecting the valve.
Man-made valves are more durable than biological valves and usually don't have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer biological valves may last 15 years or longer.
Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of IE.
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
If you're a woman of childbearing age or if you're athletic, you may prefer a biological valve so you don't have to take blood-thinning medicines. If you're elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
Other Approaches for Repairing and Replacing Heart Valves
Some newer forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3 to 5 days, compared with 5-day stays for traditional heart valve surgery.
New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter-2 to 4 weeks versus 6 to 8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring procedures that use cardiac catheterization to thread clips or other devices in a tube through your blood vessels and into the faulty valve in your heart. The clips or devices are used to reshape the valve and stop the backflow of blood. It's not yet known how well these procedures work.
The Ross operation is a surgical procedure to treat faulty aortic valves. During this operation, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. The pulmonary valve is then replaced with a pulmonary valve from a deceased human donor.
This is more involved surgery than typical valve replacement, and it has a greater risk of complications.
The Ross operation may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isn't required.
But in some patients, one or both valves fail to work properly within a few years of the surgery. Experts continue to debate the usefulness of this procedure.
Serious risks from all types of heart valve surgery vary according to your age, health, the type of valve defect(s) you have, and the surgical procedure(s) done.