Mitral valve prolapse occurs when the mitral valve doesn't close correctly, allowing blood to flow backward through the valve toward the lungs.
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What is heart valve surgery?
Heart valve surgery fixes serious valve diseases that disrupt blood flow within your heart. Valves between your heart’s four chambers open and close with each heartbeat, directing blood flow through each chamber. Doctors may recommend valve replacement or repair, depending on the type of heart valve disease.
Heart specialists at Mass General Brigham Heart and Vascular expertly perform all types of heart valve surgeries. Our Heart Valve Disease Program is one of the nation’s largest and most established. Our heart teams perform more than 3,000 heart surgeries every year, as well as a high volume of minimally invasive valve procedures that take place through a catheter (thin tube) threaded through a blood vessel to the heart. We also perform open-heart valve repairs and replacements.
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Who needs heart valve surgery?
Not everyone with heart valve disease needs surgery. Your provider may recommend a heart valve procedure if you have chest pain, heart palpitations, fatigue, and other symptoms. Severe heart valve disease can damage your heart, putting you at risk for heart failure. Heart valve surgery lowers this risk.
Types of heart valve disease that may require surgery include:
Regurgitation occurs when a heart valve doesn’t close properly, causing blood to move backward. Types of regurgitation include:
- Aortic valve regurgitation
- Mitral valve regurgitation
- Pulmonic valve regurgitation
- Tricuspid valve regurgitation
Stenosis occurs when a stiff or narrow valve opening restricts blood flow to the body. Stenosis types include:
- Aortic valve stenosis
- Mitral valve stenosis
- Pulmonic valve stenosis
- Tricuspid valve stenosis
Bicuspid aortic valve disease occurs when a person is born with an aortic valve that only has two leaflets (bicuspid) instead of the usual three (tricuspid). The condition increases the risk of aortic valve regurgitation and stenosis.
About heart valve replacement surgery
During valve replacement, doctors replace a faulty valve with an artificial one. They may use a mechanical valve or one made from human, cow, or pig heart tissue.
A heart valve replacement procedure may take place via:
- Open-heart surgery: A skilled cardiac surgeon accesses your heart through an incision in the chest. This is most often done through a sternotomy (opening the breastbone), but minimally invasive approaches may be possible in some cases. Surgical aortic valve replacement (SAVR) is a type of open-heart valve replacement surgery.
- Endoscopic heart valve surgery: A surgeon may perform thoracoscopic or robotic-assisted heart valve surgery through smaller three- to four-inch chest incisions. They use a small video camera inserted into an incision to guide the procedure.
- Transcatheter heart valve surgery: A skilled interventional cardiologist inserts a catheter through a blood vessel to implant a new valve within the diseased valve. Transcatheter aortic valve replacement (TAVR) is a transcatheter heart valve procedure.
About heart valve repair surgery
In some cases, heart valve repair may be an option instead of replacement. Depending on your condition and overall health, your care team may be able to repair your existing valve rather than replace it. Valve repair preserves much of the original valve. Our centers offer the latest in minimally invasive and surgical repair techniques.
Heart valve repair can be done through open-heart surgery and minimally invasive techniques, such as:
- Reshape or reconstruct the valve leaflets so they open and close correctly
- Remove damaged valve sections
- Place a small ring around a leaky valve to tighten it (annuloplasty)
- Repair damaged valves and surrounding structures
- Non-surgical transcatheter repair for patients who are not candidates for open-heart surgery, such as transcatheter mitral valve repair (TMVR)
Your doctor will discuss these and other repair options with you to determine the best approach for your condition and health.
Who needs heart valve repair surgery?
Heart valve repair surgery may be an option if there isn’t too much valve damage and the leaflets have normal tissue quality. Mitral valve repair surgery to repair leaky mitral valves is the most common valve repair procedure. Our heart specialists can also repair faulty aortic and tricuspid valves.
Heart valve replacement versus heart valve repair
Heart valve repair typically requires opening the chest, which increases the risk of complications. In many cases, heart valve replacement can take place through a catheter. This minimally invasive procedure is less risky. Smaller incisions during replacement procedures means patients may return to activities faster with less pain and fewer complications compared to open surgery.
Your provider will consider several factors to determine which heart valve surgery is right for you.
Benefits of heart valve surgery
Heart valve surgery restores the flow of oxygenated blood from your heart to the rest of your body and organs. Improving circulation can lower your risk of heart failure and sudden cardiac arrest. It also improves your quality of life by easing symptoms, such as chest pain and shortness of breath. After treatment, you should have more energy to enjoy life.
Risks of heart valve surgery
Heart surgery is complex and carries a risk of complications. The risks of heart valve surgery depend on the procedure and factors like your overall health. Our team of highly skilled cardiac surgeons performs more than 3,000 heart surgeries every year. This high volume, combined with our decades of experience, means a lower chance of complications and higher success rates.
Possible risks include:
- Bleeding, blood clots, and stroke
- Heart attack
- Heart rhythm changes (cardiac arrhythmia)
- Infection
Preparing for heart valve surgery
In the weeks before surgery, we’ll discuss how to prepare for heart valve surgery, answer your questions, and help you understand what to expect. Your care team carefully guides you through preparation, which is critical to successful surgery. You’ll have several tests before the procedure, such as:
- Blood tests
- Coronary angiogram
- CT or MRI
- Duplex ultrasound
- Echocardiogram
- Electrocardiogram (ECG or EKG)
Your care team will tell you when to stop taking certain medications before surgery and when to stop eating and drinking the day before surgery.
Recovery after heart valve surgery
You'll rest in the cardiac intensive care unit before moving to a room in the cardiac step-down unit, where we closely monitor your progress. Your team provides pain relievers, blood thinners, and other medications as needed.
After discharge, you will see your care team for checkups and imaging tests to ensure the new valve works properly. Your care team may recommend participating in cardiac rehabilitation a month or so after surgery. This supervised program helps you safely return to activities and strengthens your heart.
It can take up to three months to fully recover from open-heart surgery. Your care team will provide instructions for caring for your incision and managing pain. They’ll also let you know when it’s safe to resume activities like driving.
FAQs about heart valve surgery
It depends on the type of procedure you have. It can take several months to fully recover from open-heart surgery.
Open-heart surgery to replace or repair a valve is complex. When possible, we perform minimally invasive heart valve procedures, which pose less risk and ease recovery.
Most mechanical heart valves are very durable and can last a lifetime. However, they require lifelong use of blood thinners to prevent clots. Tissue valves typically last 10 to 15 years and do not usually require long-term blood thinners.
If you get a mechanical heart valve, you must take blood-thinning medications (anticoagulants) for life. These drugs prevent blood clots that cause strokes. Most people who get biological heart valves don’t need blood thinners.
Yes, you can lead a normal life after heart valve replacement. Attending all follow-up appointments and following the instructions from your providers will help you live the fullest and healthiest life possible.
