How to Prepare for Heart Valve Surgery

The heart has 4 valves that open and close to regulate the flow of blood as the heart pumps. These valves can become diseased or damaged, thus affecting the ability of the valve to open or close properly. As a result, the valve either develops stenosis (narrowing) or regurgitation (leakage) or sometimes both stenosis and regurgitation.

If the valve is badly affected and there is severe stenosis or regurgitation, this can be treated by valve surgery. Often the surgical treatment involves replacement of the valve with either a tissue valve or a mechanical heart valve. In some instances, the surgeon can repair the valve. The most common valve that can be repaired surgically is the mitral valve that is leaking and occasionally repair can be carried out for the leaking tricuspid or aortic valve as well.

Generally, if the valve can be repaired, it would be preferable to repair rather than replace it. A valve that is well repaired can function almost like a normal valve, lasts for a long time and does not need anticoagulation. If the valve cannot be repaired, then the surgeon can replace the valve with a tissue valve or a mechanical valve

Tissue valve replacement has the advantage that anti-coagulation (or blood thinning medications) is not required but it has issues of long-term durability, meaning that many patients will require a second replacement surgery when the tissue valve deteriorates after 10 years.

Mechanical valve replacement has long-term durability but patients will need to take lifelong anticoagulation to prevent clotting on the valve. If clotting happens, this can lead to stroke or a jammed device.

The choice of the type of valve replacement will depend on the patient’s age, associated medical problems and gender. There is a preference for females who plan to become pregnant and have children, to have a tissue valve so that they can avoid anticoagulation during pregnancy.

What Happens Before Surgery?

Patients will have the heart and health status assessed.  These can include a number of tests such as ECG, echocardiogram, coronary angiogram (in patients where there is a need to exclude coronary artery disease), lung function tests and blood tests.  The feasibility of valve repair will be discussed between the surgeon and the patient, but the final decision is usually made during the operation.  If the valve is not repairable, then the valve would need to be replaced.

  • Patients are advised to have a dental clearance as it is preferable for dental treatment to be carried out (if required) before the surgery
  • Smokers are advised to stop smoking at least 1 month before the surgery
  • A list of instructions will given prior to the valve surgery.  These may include instruction on stopping blood thinning medications several days before the surgery to reduce the risk of bleeding during and immediately after the surgery
  • Patients will be asked not to eat anything at least 8 hours before the surgery.  Patients will be assessed by the surgeon and anaesthetist prior to the surgery. 

What Happens During Valve Surgery

The valve surgery is done under general anaesthesia. The patient will not be aware during the surgery. The conventional approach is the routine open method but minimally invasive surgery (with a smaller incision) can be used in some patients. During the surgery, an echo probe is passed through the mouth into the oesophagus (the swallowing tube between the mouth and stomach), to visualise the affected valve and to assist the surgeon in the repair of the valve. Most patients will have a ring or band sutured to the base of the valve to tighten the valve. The echo probe placed in the oesophagus can be used to assess the results of repair. If the surgeon determines that the valve cannot be repaired, then it must be replaced with either a tissue or mechanical valve (the type of valve would usually have been discussed and determined before the surgery).

What are the Potential Risks of Valve Surgery

The potential risks of any open heart surgery include

  • Bleeding
  • Breathing problems
  • Infection
  • Stroke
  • Irregular heart rate (cardiac arrhythmia)
  • Blood clots in the leg (DVT)

After the valve repair, there is a possibility the valve may leak again.  This usually occurs after many years after the surgery but in a few patients, the valve leakage can become severe again and a second surgery may be necessary.  If this is the case, the usual preference would be to replace the valve.  

Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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