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Heart Valve Replacement - Types, Indications, Procedure, and Risks

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Heart valve replacement is surgery to correct defective heart valves. There are four valves in a human heart.

Written byDr. Shaqra Ekram

Medically reviewed byDr. Muhammad Zohaib Siddiq

Published At November 1, 2022
Reviewed AtAugust 12, 2024

Introduction

The heart has four chambers- two upper sections known as the right atrium and left atrium, and two lower sections called the right ventricle and left ventricles. Parallel to four chambers, the heart has four valves: the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Valves are a crucial part of the heart’s structure. They open and close as the blood passes through them. They mainly regulate the entry and exit of blood into the heart’s various chambers. The valves have flaps or leaflets that open and close. Valves with three leaflets open and close simultaneously.

To avoid any sort of backflow of blood, the leaflets close, and vice versa; that is why they open. The mitral or bicuspid valve helps blood to flow smoothly from the left atrium into the left ventricle. This valve has two leaflets. The tricuspid valve helps blood to flow easily from the right atrium into the right ventricle. The tricuspid valve has three leaflets. The aortic valve helps control smooth blood flow from the left ventricle to the aorta. The pulmonary valve has the primary function of allowing smooth blood flow from the right ventricle into the pulmonary artery. It has three leaflets.

What Are the Kinds of Heart Valve Disease?

Valvular heart disease is diagnosed when there is a disruptive change in one or more valves of the heart. This change brings about an overall reduction in cardiac input. Mentioned below are the various types of valvular heart diseases.

  • Mitral valve stenosis.

  • Mitral valve regurgitation.

  • Aortic valve stenosis.

  • Aortic valve regurgitation.

  • Tricuspid valve stenosis.

  • Tricuspid valve regurgitation.

  • Pulmonary valve stenosis.

  • Pulmonary valve regurgitation.

How Are Diseases of the Heart Valves Diagnosed?

Valvular heart disease may be diagnosed during a regular consultation with a physician after a few extra diagnostic tests. A stethoscope can pick up any abnormal heart murmurs and regurgitation sounds. To confirm the presence of valvular regurgitation or valvular stenosis, additional tests such as those mentioned below may be suggested. Physical examination and a detailed account of medical as well as drug history are vital for the diagnosis of valvular heart disease.

  • Electrocardiography.

  • Ultrasound of the heart.

  • Complete blood picture.

  • Doppler echocardiography.

  • X-ray of the chest.

  • Transesophageal echocardiogram.

  • Magnetic resonance imaging of the heart.

  • Catheterization.

What Are the Signs and Symptoms That Suggest a Heart Valve Replacement?

Heart valve replacement is a surgical and invasive procedure that aims to correct and treat defective heart valves to regain the standard function of the heart. Mentioned below are a few of the signs and symptoms that may help the healthcare provider decide on going forward with a heart valve replacement surgery after careful diagnosis and physical examination.

  • Dizziness.

  • Chest pain.

  • Difficulty in breathing.

  • Cyanosis or bluish discoloration of the skin.

  • Discomfort around the waist.

  • Swelling of the ankles and abdomen.

  • Increased water retention.

  • Rapid gain in weight.

  • Lethargy.

Risks of Heart Valve Replacement Surgery.

  • Excessive bleeding during the surgery or even after the surgery.

  • Blood clots.

  • Heart attack.

  • Stroke.

  • Lung disorders.

  • Infection of the blood.

  • Pneumonia.

  • Pancreatic disorders.

  • Breathing difficulty.

  • The abnormal rhythm of the heart.

  • Incorrect replacement of the heart valve.

  • Death.

How Does Heart Valve Replacement Surgery Take Place?

A Heart valve replacement surgery is a schedule management plan in a hospital setup. The exact procedures for the replacement of the heart valve may be different depending on the condition of the patient. Mentioned below are the steps that occur during a heart valve replacement surgery. Generally, open-heart valve repair or replacement follows this process:

  • IV or intravenous anesthesia is administered.

  • Multiple catheters may be inserted in the wrist and neck blood vessels to constantly monitor blood pressure.

  • Blood pressure and breathing patterns will be continuously monitored.

  • The patient is connected to a ventilator via a breathing tube that is passed down into the lungs.

  • A TEE or transesophageal echocardiogram is placed into the esophagus. This helps to monitor the functions of the valves.

  • A Foley catheter is a flexible tube that is placed through the urinary bladder to drain urine.

  • Another tube that passes through the nose or the mouth directly into the stomach is used to drain digestive fluids.

  • An incision is made according to the nature of the surgery- a longer incision in case of an open heart valve replacement surgery or a noninvasive shorter incision surgery.

  • The sternum is cut in half to expose the heart to the healthcare provider.

  • The heart is stopped to operate on the heart valves by injecting a cold solution.

  • A bypass machine of the heart and lung is placed, which can mimic the pumping and function of the heart.

  • The diseased valve is removed from the heart, and an artificial valve is replaced.

  • Once the surgery is complete, the heart receives a shock that helps it to start beating again.

  • The bypass machine is removed, and the heart functions as the standard pumping mechanism.

  • The heart valve is examined for its functions and strength and to ensure there are no leakages.

  • Pacemakers may be introduced for an initial recovery for a short span.

  • The fluid and blood accumulated around the surgical sight are drained.

  • The sternum is fixed together, and a bandage with surgical dressing is placed.

Can a Heart Valve Repair Itself?

Heart valves cannot be repaired by themselves. Once the valve disease appears, it cannot go away but worsens with time. As the disease progresses, the symptoms increase, and overall health is affected. The changes in the condition may occur either slowly or may also occur quickly.

Based on the extent of the disease, the medications can be taken. Surgery can be done and gives the long-term solution for heart valve diseases. Healthcare providers may decide about the surgery.

When Is Heart Valve Surgery Necessary?

Heart valve issues may be observed during the birth. The treatment may be necessary if the symptoms developed are:

  • Experience chest pain.

  • Feel difficulty in breathing.

  • Experience fainting.

Heart valve surgery is to be considered as it provides a long-term solution.

Conclusion

Heart valve replacement surgery is the correction and replacement of defective heart valves. This surgery is generally an invasive procedure. After the surgery, the patient must inform the healthcare provider about any irritation at the surgical site or any fever that persists. The healthcare provider should also address coughing of blood, nausea, and dizziness. Living a heart-healthy life is the key to a successful outlook after a heart valve replacement surgery.

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Frequently Asked Questions

Yes, Heart valve replacement is considered major surgery involving the replacement of defective heart valves. Yes, heart valve replacement is a dangerous surgery. It is regarded as major surgery when one or more heart valves are replaced because they are not working properly. 
The procedure is carried out through a significant incision in the patient's chest or without open heart surgery while under general anesthesia. It may take several weeks to recover after heart valve replacement surgery, and patients must be closely watched for complications. However, heart valve replacement surgery can improve heart function, ease symptoms, and lower the risk of serious complications like heart failure, which can be fatal.
Heart valve replacement can be performed without open heart surgery by a procedure known as transcatheter aortic valve replacement (TCAVR). It's a minimally invasive procedure that involves the replacement of the damaged aortic valve with a new valve through a small incision in the leg or chest. 
Mitral valve repair is a different treatment that can be carried out through a minor chest incision without stopping the heart. The decision to do open heart surgery or a minimally invasive technique depends on several variables, including the kind and severity of the valve disease, the patient's general health, and the surgeon's experience. However, not all patients are candidates for either operation.
A person can continue a normal life after having a heart valve replaced. Following surgery, many patients notice notable improvements in their symptoms and quality of life. Nevertheless, recovery can take a few weeks, so patients should adhere to their doctor's post-operative care instructions, including taking medication, attending follow-up appointments, and doing cardiac rehabilitation. Patients should also maintain a healthy lifestyle, including a balanced diet, regular exercise, and not smoking, to minimize the risk of complications and promote long-term heart health.
The life expectancy of an individual after undergoing heart valve replacement surgery depends on various attributes like the type of the valve, the surgery performed, the age of the patient, and their overall health status. According to the American heart association, the ten-year survival rate of a patient who underwent heart replacement is 60 to 90 percent. Generally, the surgery has a success rate determined by factors like the patient's lifestyle and follow-up visits to the doctor.
The type of surgery performed, the patient's general state of health, and any issues that might develop before, during, or after the surgery affect how long the patient must stay in the hospital following a heart valve replacement. Patients should typically plan on being in the hospital for five to ten days following surgery. To facilitate a speedy recovery, healthcare workers will constantly watch the patient throughout this period. The patient will be discharged from the hospital after they are stable and can carry out simple tasks.
The type of heart valve repair surgery used, the degree of valve damage, and the patient's general health all affect the procedure's success rate. The success rate of heart valve repair surgery is exceptionally high, with an average success rate of over 95%, according to the American Heart Association.  The patient's compliance with post-operative instructions, regular follow-up appointments with their doctor, and a healthy lifestyle are all crucial for the operation's success.
The aortic valve is often the heart valve that is replaced the simplest. The valve is quite simple in structure and is located closest to the surgeon's access site, making replacement easier. The aortic valve is less susceptible to calcification and infections than the other heart valves. Due to these factors, replacing the aortic valve is a reasonably simple treatment with minimal risk of complications and a speedy recovery.
If the patient develops heart block, a condition in which the electrical signals in the heart are stopped or delayed and result in a sluggish heart rate, a pacemaker may be necessary after a heart valve replacement. The surgery itself has the potential to trigger this. A pacemaker is a tiny device wired to the heart and implanted under the skin, generally close to the collarbone. It delivers electrical impulses to the heart muscle to control the heartbeat and maintain a constant heart rate. The pacemaker can enhance the patient's general quality of life and guarantee that the heart continues to operate normally following valve replacement surgery.
The type of replacement valve utilized and the patient's general condition all have a role in determining how many times a heart valve replacement procedure can be done. Bioprosthetic (tissue) valves typically last between ten and 15 years, after which they may need to be replaced. Contrarily, mechanical valves need lifelong anticoagulation medication to prevent blood clots while having a lifespan of up to 30 years or more. The choice to have additional heart valve replacement surgery is taken on a case-by-case basis and is based on the patient's unique circumstances. A second or third valve replacement procedure might be possible in some circumstances, but it might not be advised in others because of the dangers involved.
People who have had a heart valve replacement can fly after a specific amount of recovery time. Depending on a person's age, general health, and the type of valve replacement surgery used, the length of this recovery period may change. To ensure adequate healing and recuperation, it is advised that patients avoid flying for at least two weeks following their procedure. Additionally, it's critical to remember that long flights might raise the risk of blood clots, particularly for those with a history of cardiovascular illness. Therefore, patients should reduce the risk of developing blood clots, such as wearing compression stockings, drinking plenty of water, and moving around sometimes during the flight.
After receiving a new heart valve, a person can live for 20 years or longer. The patient's age, general health, and the kind of valve replacement surgery used all play a significant role in the life expectancy following heart valve replacement surgery. During surgery, patients can typically anticipate leading a normal, healthy life and returning to regular activities and exercise within a few weeks of rehabilitation.
Patients are advised to avoid activities that could tax the heart or raise their risk of problems after heart valve replacement surgery. Patients should generally avoid heavy lifting, rigorous exercise, and activities that demand extensive bending or twisting of the chest. These activities may vary based on the kind of surgery and individual characteristics, but patients should generally avoid them. Patients should also refrain from high-impact activities that could result in falls or injuries, such as contact sports, as these raise the risk of the replacement valve being damaged or bleeding. Until the surgical incision has completely healed, patients should refrain from engaging in activities that could cause infection, such as swimming in public pools.
After having an aortic valve replacement operation, a 69-year-old patient's expected lifespan is difficult to predict because so many variables are at play, including their general health, way of life, and any underlying medical issues. However, many patients can live for several years after the operation with the right medical attention and lifestyle adjustments. Aortic valve replacement patients typically have ten to 15 years of life expectancy. However, individual circumstances might dramatically affect this.
A heart valve replacement does not automatically make someone incapacitated. The seriousness of a condition and how it interferes with a person's capacity to perform everyday tasks, work, and other tasks determine whether or not that person is regarded as disabled. While some people with a heart valve replaced can resume their regular activities and lead satisfying lives with few to no restrictions, others may continue to have health problems that limit their ability to function normally. Because every case is different, each one needs to be assessed separately.
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Dr. Muhammad Zohaib Siddiq from iCliniq
Dr. Muhammad Zohaib Siddiq

Cardiology

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