Heart valve replacement surgery

Why would you have valve replacement surgery

Your heart valves help control the direction of your blood flow. If one or more of your heart valves is not working properly it can put extra strain on your heart.

If this happens you may need surgery to replace your heart valve.

You’re more likely to have your valve replaced if you have a problem with your mitral or aortic valve.

Risks and benefits

You may have heart valve disease for months or years before you have surgery. Your doctor will check your heart closely and recommend surgery when it will benefit you most.

Having your heart valve replaced can: 

• improve your quality of life, giving you more energy for everyday tasks
• reduce how hard your heart needs to work
• reduce the risk of getting other heart conditions, like heart failure
• improve symptoms.

Like any surgery, there are risks that need to be considered. Your doctor or surgeon will talk through your individual risks and benefits of surgery.

Will I need more surgery in the future?

You may need more surgery in the future. This depends on your individual circumstances, and what type of replacement heart valve you have.

In some cases, during surgery your surgeon may find that your heart valve cannot be replaced. Your surgeon will talk to you about this before you have surgery, and what will happen if they cannot replace your heart valve.

If you do not have surgery

If your heart valve needs replacing, it will not get better without surgery. You may also have a higher risk of getting an infection to your heart (endocarditis).

If you choose not to have surgery, your doctor can talk you through other options.

This could include medicine to reduce the work your heart has to do and improve any symptoms you have. They may also talk to you about care and support available, including palliative care.

Preparing for surgery

Find out more about what to do before you have surgery, including tests you will have and tips to help you feel prepared.

Types of heart valve: mechanical, biological and Ross procedure

There are two main types of heart valve that you may be offered.

1. Mechanical (metal) valve, an artificial (also known as man-made) valve, usually made from carbon.
2. Biological (bioprosthetic) valve, a biological or tissue valve, usually made from animal tissue.

Your doctor or surgeon will talk to you about what valve they think is best, but it’s your choice.

They can also give you more information on how long the valve replacement will last. If there’s a reason why one valve would not be suitable, your doctor will discuss it with you.

Difference between mechanical and biological valves

Mechanical:

• made from carbon (a light and strong material)
• less people have this type of heart valve
• usually offered if you’re younger because it can last longer
• may cause a clicking sound in your chest, but mechanical heart valves are quieter.

You’ll need to take a blood thinner medicine (anticoagulant) for the rest of your life. Because it’s made from a material that’s not natural for your body, there's a risk of blood clots. This is a normal reaction for your body to something that’s not natural tissue (known as a foreign object).

Biological:

• made from animal tissue, like the heart tissue from a pig or cow
• more people have this type of heart valve
• usually offered if you’re over 60 years old.

In most cases, you will not need to take a blood thinner (anticoagulant) for the rest of your life. Because it’s made from natural tissue, your body is more likely to accept the new valve.

If you have any questions or concerns about the type of heart valve you’re having, speak to your doctor or surgeon.

Ross Procedure

Some people may be offered a Ross procedure to replace their heart valve.

It’s used if you have a problem with your aortic valve, like stenosis or regurgitation. You're more likely to have this procedure when you're a child.

Instead of using a mechanical or biological valve, the surgeon will replace your aortic valve with your own pulmonary valve. Because your aortic valve works harder, using your own pulmonary valve means it will be able to deal with more pressure and last longer.

Your pulmonary valve is then replaced with a donated human tissue valve. The tissue used to replace your pulmonary valve can last up to 20 years.

It’s a complicated procedure so it may only be available at specialist centres. Your doctor or surgeon can speak to you about whether it’s an option.

Types of heart valve replacement surgery

There are different types of surgery to replace a heart valve.

The surgery you have will depend on:

• what valve is affected
• your current health and heart health
• any other medical conditions
• recovery time and how it will affect your daily life
• if you need other surgeries or procedures.

The way the surgeon gets to your heart to fix it is different depending on the type of surgery you’re having. You may have open heart surgery or a minimally invasive procedure.

Open heart surgery

During open heart surgery, the surgeon will work directly on your heart to replace your heart valve.

Before surgery you’ll be given general anaesthetic. This is like being asleep and you do not feel any pain.

There will be monitors to check your heart rate, blood pressure and oxygen levels. You’ll be put on a bypass machine, also known as a heart and lung machine. This helps pump blood around your body during surgery.

The surgeon will cut the bone in your chest so they can see your heart (called a sternotomy). They will then replace your heart valve.

If you need surgery for other heart conditions you may be more likely to have these at the same time as open heart surgery. This is to reduce the chances of you needing another sternotomy.

Minimally invasive and transcatheter procedures

Minimally invasive surgery or transcatheter procedures are done using small cuts and few stitches. There are different types of procedures.

• Mini thoracotomy, the most common surgery. A cut is made in the right side of your chest to get to your heart.
• Partial sternotomy, part of the bone in your chest is cut to get to your heart. It’s usually cut at the bottom.
• Multiple small cuts, cameras are used to guide the procedure and get to your heart. This is more likely to be used if you’re having robotic-assisted surgery.
• Transcatheter procedures, a tube (called a catheter) is guided to your heart through a small cut in your arm, leg or chest.

Your doctor or surgeon can give you more information about the type of surgery you’re having, and what to expect.

Recovery after surgery

Find out more about recovery in hospital and when you go home on our heart surgery webpage. 

If you’re struggling with any side effects or symptoms speak to your doctor or nurse specialist. Your GP may also be able to recommend ways to support you.

Living with a replacement valve

It’s normal to worry about your heart after having surgery, and how it will affect your daily life.

If you’ve had a minimally invasive procedure, you should be able to do most of your normal activities after about 6 weeks, including working, driving and sex. If you’ve had open heart surgery it’ll take longer, usually up to 12 weeks.

You can find information on what to expect in our booklet on heart surgery.

Talk to your doctor or nurse specialist about living with a replacement heart valve. It’s ok to ask questions, even things that feel difficult or uncomfortable to talk about.

More information and support

It’s normal to feel worried about heart surgery. It can help to talk about how you feel with your partner, a friend, relative or healthcare professional.

• Speak to one of our cardiac nurses by calling the Heart Helpline.
• Read our recovery tips after surgery.
• Join our online support community HealthUnlocked.
• Talk to other people with heart valve disease on the Heart Valve Voice group.
• Find more information and support from the British Heart Valve Society.
• Read about our research into heart valve disease and treatments.