Heart valve surgery is done at a hospital by a heart surgeon, called a cardiovascular surgeon. To get the best results, the surgery should be done at a medical center with medical teams experienced in doing heart valve surgery.
Before the procedure
Before heart valve surgery starts, a member of your care team may shave any body hair from your chest area. A special soap is used to wash your skin. The soap kills germs and helps prevent infection.
A healthcare team member places a needle in a vein, usually in your arm. The needle has a tube connected to it. This is called an IV. Medicines and fluid go through the IV. You may get medicines to help you relax.
During the procedure
What happens during heart valve surgery depends on the type of surgery being done.
You get medicines to put you in a sleeplike state during heart valve surgery. This is called general anesthesia. You are usually connected to a heart-lung bypass machine. The machine keeps blood moving through your body during surgery.
Heart valve surgery can be done in different ways.
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Open-heart surgery. The surgeon makes a cut, called an incision, through the middle of the chest to reach the heart.
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Minimally invasive heart surgery. This surgery uses much smaller cuts than open-heart surgery. It may mean a shorter hospital stay, less pain, a quicker recovery and fewer complications. An example of minimally invasive heart valve surgery is thoracoscopic surgery or mini-thoracotomy.
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Robot-assisted heart surgery. This is a type of minimally invasive surgery. A surgeon uses robotic arms to do the same movements used in open-heart surgery.
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Catheter treatment. Some heart valve repairs are done using a long, thin tube called a catheter and clips, plugs or other devices. A surgeon can pass tools through the catheter to repair or replace the heart valve.
There are two basic types of heart valve surgery:
- Heart valve repair.
- Heart valve replacement.
Heart valve repair
Heart doctors recommend heart valve repair when possible. It saves the heart valve. It also helps keep the heart working as it used to. Some heart valve repairs also may improve survival when compared with valve replacement. Some heart valve repairs are done using a long, thin tube called a catheter and clips, plugs or other devices. Other times, open-surgery is needed.
During heart valve repair, a surgeon might:
- Patch holes in a valve.
- Rebuild valve flaps, also called leaflets or cusps.
- Remove extra valve tissue so that the valve flaps can close tightly.
- Replace or remove pieces of tissue called cords that are diseased and no longer support the valve.
- Widen a narrowed valve using a thin flexible tube and a tiny balloon. This is called a balloon valvotomy.
- Separate valve flaps that have joined together.
- Tighten or strengthen a ring around the valve, called the annulus.
Heart valve replacement
If your heart valve can't be fixed and other treatments aren't possible, you may need heart valve replacement. A surgeon removes the heart valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue. Valves made from living tissue are called biological tissue valves.
Your healthcare team typically talks with you about the benefits and risks of each type of valve.
- Biological valves can wear out over time. They need to be replaced if this happens.
- Mechanical valves usually do not wear out over time. But if you have a mechanical valve, you need to take blood-thinning medicines for life to prevent blood clots.
Surgeons and other heart doctors can replace some heart valves using thin, flexible tubes called catheters. For example, this type of minimally invasive surgery might be done to put a biological valve in the heart to replace a valve that no longer works.
After the procedure
After heart valve surgery, you usually spend a few days in the hospital. How long you stay in the hospital depends on your specific condition and surgery.
During your hospital stay, your healthcare team frequently checks your breathing, blood pressure and heart rate. Your team also watches for signs of infection. You usually get:
- Oxygen.
- Fluids and medicines, including pain medicine, through an IV.
- Tubes to drain urine from your bladder and fluid and blood from your chest.
While in the hospital, your healthcare team helps you:
- Slowly increase your activity.
- Take longer and longer walks in the hospital.
- Do breathing exercises.
Your care team gives you instructions to follow during recovery, such as:
- How to care for your surgical cuts.
- How to manage pain and other side effects.
- How to know if you have an infection.
- What medicines to take and when.
- When to call your healthcare team.
After heart valve surgery, your healthcare team tells you when you can go back to your usual activities. This includes working, driving, sexual activity and exercise.