Categories: Cardiology

Surgical Options for Heart Valve Replacement

The heart is the vital organ of the body that pumps blood all through the body and collect back waste metabolites to be excreted. The heart has 4 chambers 2 upper atrium and 2 bottom ventricles. The atrium and ventricles are separated by valves, which provide unidirectional blood flow. The main purpose of the heart is oxygenation of blood. The left ventricle opens in the aorta that supplies oxygenated blood to the body via other arteries. The left ventricle and aorta are separated by an aortic valve.

Sometimes there are problems with the working of heart valves causing the mixing of blood leading heart to function extra hard to attain a similar supply.

Valve replacement treats severe valve diseases and brings the heart function back on track.

Condition in which heart valve replacement is indicated:

  • Aortic valve regurgitation- Backward flow of blood from the aorta to the left ventricle
  • Aortic valve stenosis-Less blood is pumped into the aorta due to narrowed valves
  • Mitral stenosis-Less blood is pumped from left atrium to left ventricle
  • Mitral regurgitation- Backward flow from the left ventricle to the left atrium

The valve pathologies are either birth defects or associated with rheumatic heart diseases. Many of these can be managed by medication alone. But in most cases, surgery is required to treat the defect permanently. Over time these defects may result in severe complications like heart attack, heart failure, stroke, and even deaths.

Surgical options for valve replacement include:

  • Mechanical valve — a long-lasting valve made of durable materials
  • Tissue valve (which may include human or animal donor tissue) last 10-20 years
  • Ross Procedure — “Borrowing” your healthy valve and moving it into the position of the damaged valve aortic valve
  • TAVI/TAVR procedure — Transcatheter aortic valve replacement
  • Newer surgery options like donor valve implantation- Human donor valves, only used in conditions like infective endocarditis

How to decide which valve or procedure is right for my loved one?

Both the decisions are extremely important as recovery and quality of life both depend on them. The patient may have to take blood-thinning medications all through life in order to lower the risk of embolism. For the decision following factors are usually considered

  1. Severity of cause
  2. Age
  3. Overall health
  4. Overlapping heart condition if at all

Heart replacement surgeries performed as open-heart surgery with an incision in the chest or through minimally invasive techniques. Step by step Procedure

  • Anesthesia is administered
  • The patient is kept on the heart-lung bypass machine to ensure circulation
  • Sternum or chest bone is cut open
  • A defect is addressed either by
  1. Implanting tissue to patch holes or tears in the flaps (torn cusps) that closes off the defect in the valve
  2. Supplying support at the base of the valve
  • Separating fused valve cusps
  1. Restructuring or removing valve tissue to allow it to close more tightly. The valve may be artificial or animal. In some cases, the patient’s pulmonary valve tissue is used to repair the defect(ross procedure)
  2. Compression the ring around the valve (annulus) by implanting an artificial ring (annuloplasty)

The post-surgery patient is kept in the hospital for a few days. Once fully recovered you will be discharged and taught incision holding techniques.

Minimally invasive techniques are performed by balloon valvoplasty through cardiac catheterization. A long thin tube called a catheter is inserted in an artery of groin, neck or arm that passage its way to the patient heart.

  • 6-hour fasting is required
  • Image-guided
  • Local anesthesia is administered at a site
  • A small cut is made at groin and neck  to insert catheter and device
  • Device closes the hole and the leak and repair is fixed with the help of a clip or plug
  • In the case of balloon valvoplasty, a catheter will be threaded through the valve. After this, a balloon is blown to open it broader. This procedure is called TAVR and is apt for people who are at intermediate or high risk of complications from surgical aortic valve replacement
  • In the case of valve replacement similar catheter and device are inserted but instead of a balloon, a new (artificial or tissue) valve is rooted to replace the old nonfunctional one.

Post Procedure Recovery

After the sheath is removed from your groin and neck and the effect of anesthesia is worn off, you are supposed to lie for many hours to allow the major vessels to heal. The patient may be allowed to go home the same day or next, depending on recovery and healing.


Complete recovery within 8weeks with blood-thinning medications for life. A healthy lifestyle full of the right food, physical exercises, no tobacco, and less alcohol needs to be practiced.

Valve replacement is no longer that frightful procedure. A lot of options in minimally invasive techniques have changed the way it worked. Not even is the cost of surgery reduced, the quality of life has also improved. This is what we call the healthcare delivery paradigm shift.

Dr. Rachit Saxena, Senior Consultant – Cardiac Surgery – Adult | Narayana Superspeciality Hospital, Gurugram

Narayana Health

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