Valve Surgery

The heart has four valves that keep blood moving in one direction. A valve can fail in two ways: it can become narrowed (stenosis), forcing the heart to work harder to push blood through, or it can become leaky (regurgitation), allowing blood to flow backwards so the heart has to pump the same volume twice. Both place the heart under a load it cannot sustain indefinitely.

Repair or replacement

Where a valve can be repaired, repair is usually preferred. Keeping your own valve tissue preserves the natural architecture of the heart, generally avoids lifelong blood thinning, and carries a lower risk of valve infection. Mitral valves in particular are often repairable. When the valve is too damaged, calcified, or distorted to give a durable repair, replacement is the better option — a poor repair is not preferable to a good replacement.

Types of replacement valve

• Mechanical valves are extremely durable and usually last a lifetime, but require lifelong anticoagulation with warfarin and regular INR monitoring.
• Tissue (biological) valves generally avoid the need for long-term anticoagulation, but wear out over time and may eventually need replacing.

The choice is genuinely shared. Age matters — tissue valves tend to last longer in older patients — but so do plans for pregnancy, occupation, bleeding risk, access to INR monitoring, and how a patient feels about the possibility of a second operation versus taking daily anticoagulation.

Timing

Timing is one of the most important parts of valve treatment. Operating too early exposes a patient to risk before it is needed; operating too late allows irreversible damage to the heart muscle, so that symptoms improve less than they should. This is why patients with known valve disease are followed with regular echocardiograms even while they feel well — the scan often shows the heart beginning to change before symptoms appear.

Causes of valve disease

Common causes include degenerative change with age, rheumatic heart disease following untreated streptococcal throat infection, congenital differences such as a bicuspid aortic valve, infection of the valve (endocarditis), and secondary leakage when the heart chamber enlarges.

Living with a replaced valve

Most patients return to full activity. Anyone with a prosthetic valve needs good dental hygiene and regular dental review, because infection entering the bloodstream can settle on a prosthetic valve. Patients on warfarin need stable monitoring. Any new fever, breathlessness, or change in exercise tolerance should be reported promptly rather than waiting for a routine appointment.

This page is general education, not advice about your own valve. The right operation and the right timing depend on your echocardiogram findings and your individual circumstances.