Overview

Why is it necessary?

Reasons for having a heart valve replacement

A heart valve replacement may be recommended if you have severe heart valve disease and it's not possible to repair your heart valve.

It can treat different types of heart valve disease including:

• aortic stenosis or mitral stenosis, where your aortic or mitral valve is too narrow and does not open fully
• aortic regurgitation or mitral regurgitation, where your aortic or mitral valve does not close fully and is leaky
• a bicuspid aortic valve, a condition some people are born with where the aortic valve has only 2 flaps instead of 3

Heart valve replacement helps with symptoms of heart valve disease such as chest pain, feeling dizzy, shortness of breath, heart palpitations and feeling tired.

It's also sometimes recommended to treat severe heart valve disease even if you do not have symptoms. It helps to prevent your condition getting worse and leading to heart failure, where your heart cannot pump blood as well as it should.

A heart valve replacement is usually very successful, but it's a major operation that has risks. It will only be recommended if the benefits outweigh the risks for you.

Alternatives to a heart valve replacement

A heart valve replacement is not always needed to treat heart valve disease.

Mild heart valve disease with no symptoms may not need any treatment.

Symptoms of mild or moderate heart valve disease can usually be treated with medicines.

If you have severe heart valve disease, there are other surgical treatments that may sometimes be recommended instead of heart valve replacement.

These are not suitable for everyone, but might include:

• surgery to repair your heart valve, if it's not seriously damaged – this is done by making a large cut in your chest or smaller cuts between your ribs
• using a clip to repair a leaky heart valve – the clip is inserted by passing a thin tube (catheter) through a blood vessel in your upper leg
• widening a narrowed heart valve using a small balloon that's passed into your heart through a catheter in your upper leg (balloon valvuloplasty)

How is it performed?

What happens during a heart valve replacement

A heart valve replacement is done in a specialist hospital. Depending on the type of surgery, you may need to stay in hospital for about a week.

The type of replacement valve and surgery that's recommended for you will depend on what type of heart valve disease you have, your preferences and things like your age and general health.

Your doctor will explain the benefits and risks of each option.

Types of replacement heart valve

There are 2 main types of replacement heart valve:

• mechanical (artificial) valves, made from carbon and metal
• tissue valves, made from tissue from humans or animals (pigs or cows)

Mechanical valves are usually recommended for younger people, as they last a long time and do not usually need to be replaced. But they increase the risk of blood clots, so you'll need to take anticoagulant medicines for the rest of your life.

Tissue valves usually last from 15 to 20 years, so you may need to have the valve replaced again. They're usually recommended for older people and people who cannot take or do not want to take anticoagulants, as they do not increase the risk of blood clots.

Types of heart valve replacement surgery

Open heart surgery

This is the most common type of surgery for heart valve replacement.

The main steps are:

1. You're given a general anaesthetic, so you're asleep during the operation.
2. The surgeon makes a long cut down the centre of your chest, through your breastbone.
3. Your heart is connected to a machine to keep blood flowing around your body during the operation (heart-lung bypass machine).
4. The surgeon cuts into your heart to reach the damaged valve.
5. They remove the damaged valve and stitch the new valve into place. Your heart is then closed.
6. Your heart starts pumping blood again and the heart-lung bypass machine is disconnected.
7. Your breastbone is closed using metal wires.
8. The cut in your chest is closed using stitches that dissolve so they do not need to be removed.

Minimally invasive surgery or keyhole surgery

Sometimes it may be possible to replace your heart valve by making smaller cuts in your chest. Recovery is usually quicker if you have this type of surgery, but it's not always suitable.

The main steps are:

1. You're given a general anaesthetic, so you're asleep during the operation.
2. The surgeon makes one larger cut and several smaller cuts in your chest.
3. A camera is put into your chest through the larger cut, and tools through the smaller cuts.
4. Your heart is connected to a machine to keep blood flowing around your body during the operation (heart-lung bypass machine).
5. The surgeon cuts into your heart to reach the damaged valve.
6. They remove the old valve and stitch the new valve into place. Your heart is then closed.
7. Your heart starts pumping blood again and the heart-lung bypass machine is disconnected.
8. The cuts in your chest are closed using stitches that dissolve so they do not need to be removed.

Transcatheter aortic valve implantation (TAVI)

This procedure may be recommended to treat aortic stenosis (a narrow aortic valve), if other types of surgery are not suitable or could be too high risk for you.

This could be because of your age or because you're too unwell to have open heart surgery.

The main steps are:

1. You're awake during the procedure. You're given a medicine to help you relax (sedative), and a local anaesthetic so you do not feel any pain.
2. A thin tube called a catheter is passed through a blood vessel in your upper leg, arm or chest to reach your heart.
3. A new replacement valve is inserted through the tube and fixed in place on top of your damaged valve.
4. The tube is then removed.

It usually takes 1 to 2 hours. Your heart does not need to be stopped during the procedure and the old valve is not removed.

After the operation

If you had open heart surgery or minimally invasive surgery, you'll usually be taken to intensive care after the operation.

When you wake up from the anaesthetic:

• you'll be attached to machines that check how your heart and lungs are working
• you'll be given oxygen through a mask over your mouth and nose
• you'll have tubes in your chest, which will be removed after 1 or 2 days
• you'll be given pain relief

Recovery

How to recover from a heart valve replacement

It usually takes 2 to 3 months to fully recover from a heart valve replacement if you had it done with cuts in your chest (open heart surgery or minimally invasive surgery).

Recovery is quicker if you had it done using a catheter passed into a blood vessel in your leg (transcatheter aortic valve implantation, or TAVI).

After a heart valve replacement:

• you'll have a wound in your chest from the surgery, or a small wound where a catheter was inserted
• if you had wires in your breastbone, they'll usually be left in place permanently
• you may have some pain in your chest, back or shoulders
• you'll usually feel tired for the first few weeks
• you may have less appetite than usual for the first few days

Recovering in hospital

You'll usually spend about a week in hospital, or 2 to 3 days if you had TAVI.

You'll have some pain or discomfort. You'll be given pain relief to help with this.

You'll have help from nurses and physiotherapists to start getting out of bed and moving around from the day after the operation.

You can go home once doctors are happy that you can safely get around and are recovering well. You'll need to arrange for someone to drive you home.

Recovering at home

You'll have follow-up appointments to check how you're recovering. You may also be offered a programme of exercise and support to help you recover (cardiac rehabilitation).

You should find that your heart valve disease symptoms such as chest pain and shortness of breath improve.

If you have a mechanical heart valve, you'll be prescribed an anticoagulant medicine (usually warfarin). You'll need to take this for the rest of your life to help prevent blood clots.

Your care team will give you advice about things to do to help your recovery.

Do

• try to arrange for someone to help look after you for at least the first few days after you go home
• follow your care team's advice about caring for your wounds while they heal
• take painkillers if you need them
• start being active, such as going for walks, as soon as you feel well enough
• follow your care team's advice about exercise to help you build up your fitness
• eat a healthy, balanced diet to help keep your heart healthy
• look after your teeth and gums, and have regular dental check-ups, as dental problems can lead to a serious infection in your heart (endocarditis)
• tell your dentist that you've had a heart valve replacement if you need any dental treatment – you may need to take antibiotics
• if you take warfarin, carry the anticoagulant alert card that you're given, and show this to the person treating you before you have any medical or dental procedures
• if you take warfarin, be careful when doing activities that could cause cuts or bruising, as warfarin can make you bleed more than normal
• if you have a bus, coach or lorry licence, tell the DVLA that you've had a heart valve replacement on the GOV.UK website

Don’t

• do not do any heavy lifting for 3 months
• do not drive for at least 4 weeks (or 3 months if you have a bus, coach or lorry licence)
• do not smoke – get help to quit smoking if you need it

Read the British Heart Foundation's guide to having heart surgery

Risks