ECG signal

Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Treatments - Valve Repair / Replacement

Heart valve surgery has a history dating back more than 60 years; during this time surgical techniques and types of artificial heart valve (prostheses) have been refined such that with appropriate patient selection excellent long term outcomes can be reliably achieved. With the ageing of the general population we are seeing an increase in the number of older patients developing valvular heart disease and requiring surgery; if a heart valve becomes narrowed or leaky to a point where it is putting strain on the heart then a new valve, or repair of the existing valve, might be required. Conventional treatment is with surgery, although the role of percutaneous “keyhole” treatment, such as TAVI (transcatheter aortic valve implantation) and the MitraClip, is undergoing rapid development.

Where technically possible surgical repair is favoured over replacement in patients with mitral regurgitation, a leaking mitral valve; otherwise the valve will need to be replaced with an artificial (prosthetic) valve. In most other cases of valve disease a replacement is required. There are two broad categories of prosthetic valve, biological (also called tissue or bioprosthetic) and mechanical (metal). Patients with a mechanical valve will need to take an oral anticoagulant, such as warfarin, for life to prevent clots forming on the valve and causing problems. Bioprosthetic valves are typically made from pig, cow or human donors; they do not have the same tendency to form clots and so warfarin is not generally required. Mechanical valves tend to last longer than bioprosthetic valves, particularly in younger patients, but many other technical factors influence the choice of valve prosthesis; this is an important decision and should be discussed thoroughly with a surgeon so that the pros and cons of each particular prosthesis are fully understood.

Valve surgery is undertaken in a similar way to bypass surgery and involves a heart-lung bypass machine. Traditionally an incision, known as a median sternotomy, is made vertically through the breast bone, although more recent techniques using minimal access with far smaller incisions are under development. The heart is opened to explore the damaged valve, which is then removed and a new valve sewn in its place. The patient should expect to be in hospital for 7 to 10 days after the operation. Some patients may require a permanent pacemaker in the early days after an operation; more so in cases of aortic stenosis, since the chalky deposits within the valve can extend into the adjacent electrical pathways of the heart. Sometimes the need for a permanent pacemaker can be predicted pre-operatively.

After surgery the patient should expect to be followed up regularly for life by a cardiologist to check on the function of the valve, together with the other heart valves, and to ensure that the most appropriate medication is being used to keep them well in the long term.

Download and print

Treatments - Valve Repair / Replacement