Heart valve surgery is used to repair or replace diseased heart valves.

Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four valves in your heart:

• Aortic valve
• Mitral valve
• Tricuspid valve
• Pulmonary valve

Valve replacement; Valve repair; Heart valve prosthesis

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.

In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

Minimally invasive valve surgery is done through much smaller cuts than open surgery. There are several different techniques used:

• Laparoscopy or endoscopy
• Percutaneous surgery (through the skin)
• Robot-assisted surgery

If your surgeon can cover your aortic valve, you may have:

• Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
• Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as cloth, metal (stainless steel or titanium), or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 12 - 15 years, but you may not need to take blood thinners for life.

For more detailed information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

You may need surgery if your valve does not work properly.

• A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
• A valve that does not open fully will restrict blood flow. This is called stenosis.

You may need heart valve surgery for these reasons:

• Changes in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
• Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
• Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason.
• Your heart valve has been damaged by infection of the heart valve (endocarditis).
• You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Some of the heart valve problems treated with surgery are:

• Aortic insufficiency
• Aortic stenosis
• Mitral regurgitation - acute
• Mitral regurgitation - chronic
• Mitral stenosis
• Mitral valve prolapse
• Pulmonary valve stenosis
• Tricuspid regurgitation

The risks for any anesthesia include:

• Problems breathing
• Reactions to medications

The risks for any surgery include:

• Bleeding
• Blood clots in the legs that may travel to the lungs
• Infection, including in the lungs, kidneys, bladder, chest, or heart valves

The risks for cardiac surgery include:

• Death
• Heart attack
• Irregular heartbeat (arrhythmia)
• Kidney failure
• Post-pericardiotomy syndrome -- low-grade fever and chest pain that can last for up to 6 months
• Stroke
• Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.

For more information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

For more information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

The average hospital stay is 5 - 7 days. Complete recovery will take a few weeks to several months, depending on your health before surgery.

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

Mechanical heart valves do not often fail. Artificial valves last an average of 8 - 20 years, depending on the type of valve. However, blood clots can develop on these valvves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

The clicking of mechanical heart valves may be heard in the chest. This is normal.

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patiens with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.

There are four valves in the heart: aortic valve, mitral valve, tricuspid valve, and pulmonary valve. The valves are designed to control the direction of blood flow through the heart. The opening and closing of the heart valves produce the heart-beat sounds.

Heart valve replacement may be recommended for:

• narrowing of the heart valve (stenosis)
• leaking of the heart valve

Valve problems may be caused by infections (rheumatic fever) or birth defects and may cause heart failure (congestive heart failure) and infections (infective endocarditis).

The surgery is done while the patient is deep-asleep and pain-free (general anesthesia). An incision is made through the breast bone (sternum).

Heart valve surgery is open-heart surgery. Tubes are used to re-route the blood away from the heart to a heart-lung bypass machine to keep the blood oxygenated and circulating while the heart is being operated on.

Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical). Natural valves are from human donors (cadavers), modified natural valves are from animal donors (porcine: pigs) which are placed in synthetic rings, and artificial valves are made of metal or plastic. Natural valves rarely require life-long medication to prevent blood clot formation (anticoagulation), whereas artificial valves will require anticoagulation.

The advantage of mechanical valves is that they last longer-thus, the tradeoff of lifelong anticoagulation in some cases is worth it to avoid a second valve replacement surgery.

The ineffective mitral valve is removed and the heart valve replacement is sutured into place.

The rate of success of heart valve surgery is high and increasing. The operation provides symptom relief and prolongs life. The death rate varies depending on the heart valve and averages 2% to 5%. Approximately 2 out of 3 patients who received an artificial mitral valve are still alive 9 years after the surgery. Life-long anticoagulant therapy is necessary for patients with artificial heart valves. The clicking of the mechanical heart valve may be heard in the chest and is normal.

The first 2 or 3 days following the operation are spent in an intensive care unit where heart functions can be monitored constantly. The average hospital stay is 1 - 2 weeks. A few weeks to several months should be allowed for complete recovery, depending on health before surgery.

Review Date: 05/06/2011

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A leaky valve is a condition in which the blood flow is altered by a valve that allows blood to flow backwards, otherwise known as "regurgitation".

Regurgitation can negatively impact the flow of blood across each of your four heart valves - aortic valve, pulmonary valve, mitral valve and tricuspid valve.

Ultimately, leaky heart valves force the heart to "work harder" as it re-pumps blood through a valve. Over time, this can lead to several leaking heart valve symptoms and an enlarged heart.

Some of the most common symptoms of leaky heart valves are:

• Shortness of breath, especially with exertion or when you lie down
• Fatigue, especially during times of increased activity
• Cough, especially at night or when lying down
• Heart palpitations - sensations of a rapid, fluttering heartbeat
• Swollen feet or ankles
• Heart murmur
• Excessive urination
• Chest pain (angina) or tightness
• Feeling faint or fainting with exertion
• Dizziness

Leaking heart valve symptoms do not always appear, or manifest, simultaneously for a patient. Many patients can be asymptomatic even though they suffer from mild, moderate, or even severe, heart valve disease.

If you are experiencing symptoms, it's important to know that there are a number of different heart valve diseases and valve defects that could trigger leaky heart valve symptoms.

It is recommended that those who believe they are experiencing any of the leaking heart valve symptoms identified above visit their doctor or cardiologist. Some heart valve diseases can be easily identified by listening to your heart valve sounds with a stethoscope. This is usually the first step in diagnosing a heart valve disease or leak in the valve.