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Heart Valve Repair and Replacement

Many individuals with heart valve disease do not even experience symptoms. But if you do, you might be able to manage symptoms with medication or with surgery. Many factors influence the treatment plan for heart valve disease, including your overall health, heart health, age and lifestyle.

Generally speaking, the most common heart valve diseases involve problems with:

  • The valve not opening completely: The valve may become hardened due to calcium deposits or scarring, preventing blood from passing into the next chamber. This narrowing is called stenosis.
  • The valve not closing tightly: Because the valve structures become loose, torn or stretched, it can be "floppy." This is called prolapse.
  • Blood leaking backward into the previous chamber. This condition is called regurgitation; it frequently results from floppy, leaking valves (prolapse).

More specifically, the most common heart valve diseases are:

  • Mitral valve prolapsed: Bulging, "floppy" leaflets in the mitral valve.
  • Mitral valve regurgitation: When blood leaks backward into the lungs.
  • Aortic valve stenosis: Narrowing of the aortic valve, which restricts blood flow to the rest of the body. In each condition, the heart must work harder to pump blood to the rest of the body.

Heart Valve Surgery

Treatment for heart valve disease typically begins with medications. If necessary, heart valve surgery can be performed to repair a defective valve or replace it altogether. Heart valve repair is most common with the mitral valve. Various techniques can be applied to mend a diseased mitral valve. If fused together, valve leaflets can be separated (commissurotomy). If the leaflets are floppy, a section can be cut out and sewn back together (resection). Likewise, if the leaflets are opening too wide, it can be reshaped or tightened by sewing a ring around the valve's opening (annuloplasty).

If a heart valve requires replacement, two types of prosthetic replacement valves are available:

  • Mechanical valves: These are created from man-made materials. They are extremely durable and can last up to 40 years. Unfortunately, mechanical valves entail a risk of blood clot formation, which requires that patients must take an anticoagulant (blood-thinning medication) on a lifelong basis.
  • Biological (tissue) valves: These are harvested from a pig, cow or human donors. Tissue valves are less durable than mechanical prostheses, lasting 10 to 15 years. However, they do not require long-term use of an anticoagulant to prevent blood clots. Tissue valves are used primarily in patients age 75 or older, who cannot take blood thinners.

To access the heart, a surgeon may use traditional or minimally invasive techniques. In traditional heart valve surgery, an incision is made down the center of the sternum (breastbone) to access the heart directly. In minimally invasive heart valve surgery, smaller incisions are used, resulting in reduced blood loss, trauma and length of hospital stay. Minimally invasive procedures are becoming much more common for heart valve surgery.

To perform either type of valve surgery, the heart must be stopped. A heart-lung machine mechanically performs the work of the heart and lungs. After the aorta is clamped, tubes are inserted into the right atrium of the heart to channel blood to the heart-lung machine's membrane oxygenator. The machine removes carbon dioxide from the blood and returns freshly oxygenated blood to the body.

Treatment for Mitral Valve Prolapse and Mitral Valve Regurgitation

If you have mitral valve prolapse, beta-blockers can slow the heart rate and alleviate symptoms related to irregular heartbeat: palpitations, anxiety and chest pain.

Many cases of mitral valve prolapse do not result in problematic regurgitation, where blood leaks backward. But in some rare cases, regurgitation can become severe, requiring surgical mitral valve repair or replacement.

In recent years, mitral valve repair techniques have advanced rapidly, offering many advantages over valve replacement surgery. Mitral valve repair preserves heart function, has a lower risk of infection and eliminates the need for lifelong anticoagulant medication.

In all cases, valve repair is favored over valve replacement. Mitral valve replacement surgery — involving mechanical or tissue valves — is available for patients who aren't candidates for repair techniques.

Treatment for Aortic Valve Stenosis

In some cases, medications can help manage aortic valve stenosis. For example, diuretics can help relieve pressure related to fluid buildup in the lungs. But medications cannot reverse the condition. Other ways to treat it include:

  • Balloon valvuloplasty: A nonsurgical repair technique for patients who are too ill to undergo surgery. In this treatment, a flexible, thin tube (a catheter) with a balloon tip is guided along a blood vessel in the thigh or arm, toward the aortic valve. At the right position, the balloon will inflate, pushing open and stretching the narrowed valve.

    The main drawback is that it usually has temporary results: The narrowed valve will begin to close again within six to 18 months after the procedure. It's therefore viewed as a bridge therapy that can alleviate symptoms prior to aortic valve replacement.
  • Aortic valve replacement surgery: The most commonly performed treatment for aortic valve stenosis. A surgeon removes the malfunctioning aortic valve and replaces it with a mechanical or tissue valve.
  • The specialized Ross Procedure: A leading aortic valve replacement surgery in which the patient's healthy pulmonary valve replaces the diseased aortic valve. In turn, the pulmonary valve is replaced by a valve from a human donor.

    The Ross Procedure is ideal for younger patients. It avoids degeneration associated with tissue valves and offers an alternative to anticoagulant medications required by mechanical valves.