Understanding Your Options for Heart Valve Surgery
It’s a complex procedure, with several different approaches. We asked the experts to help us sort it out.
When you schedule an appointment with your doctor because you’re feeling extra-tired lately, or find yourself getting winded doing the simplest things, heart valve disease is probably the last thing on your radar. So getting the news that one of the valves in your heart may not be working well is understandably a surprise; learning that it may need to be repaired or replaced can be downright overwhelming.
The sort-of good news is that heart valve replacement surgery has become increasingly common in recent years, and the techniques available have evolved significantly as well, says Homam Ibrahim, M.D., a cardiologist at NYU Langone Health in New York City. From the basics about your valves to the very latest in surgical options, here’s what you need to know.
Understanding Heart Valves
First, the basics. There are four valves in your heart: tricuspid, pulmonary, mitral, and aortic. These valves keep blood flowing in the correct direction through your heart. When working correctly, each valve has a flap that opens and closes once during each heartbeat. If you have been told you have heart valve disease, then at least one of the four heart valves is not functioning as it should, causing a disruption of blood flow through your heart to the rest of your body (which is why you might be feeling tired).
Generally, there are two basic types of heart valve defects: The first is the narrowing of a valve, called stenosis, which make it tough for blood to flow through. The second defect can be a leak in the valve, caused by a faulty flap, that allows blood to back up (this is known as regurgitation).
When to Consider Heart Valve Surgery
“Depending on which heart valve is not working correctly, a person may be experiencing a variety of symptoms including shortness of breath, chest pain, or dizziness and know they need to be checked out by their doctor,” says Dr. Ibrahim. At that point, your doctor will likely recommend an echocardiogram, he says. This can show if you have valve disease, and if you do, how severe it is. “If the disease is severe, it is time to fix the problem before there are long-lasting consequences,” he says.
Sometimes it’s possible to repair a damaged valve. But if the valve cannot be repaired, then valve replacement surgery is required. This involves removing the valve that isn’t working well and replacing it with a biological or a mechanical valve. The aortic valve and mitral valve are the most commonly replaced heart valves.
If you and your doctor decide to go forward with valve replacement, there are more options than ever to choose from. Surgical approaches for valve replacement include:
Mechanical valve: A mechanical valve is made from plastic and metal. These valves rely on hinged "doors" that work like the flaps in natural valves.
Tissue valve: Tissue valves, also called biologic or bioprosthetic valves, are made from valves harvested from a human (such as an organ donor who died suddenly).
Ross procedure: This procedure is also known as the Switch procedure because the surgeon will “borrow” a healthy valve and move it into the position of the damaged valve and replace the “borrowed” valve with a new valve.
TAVI/TAVR procedure: Also known as a valve within a valve, this procedure involves inserting a new valve inside of the old valve and leaving the old valve in place.
TEER procedure: Also referred to as transcatheter mitral valve repair, TEER involves clipping together a portion of the mitral valve leaflets for a condition where the mitral valves do not close properly.
These procedures can be performed in one of two ways: “Either with open heart surgery or using a transcatheter approach,” says Dr. Ibrahim. “Open heart surgery involves cutting the chest open while a transcatheter approach is a more minimally invasive procedure that involves just a small incision.”
Which type of surgery you have will depend on a variety of factors. “For example, if you are living with conditions such as lung disease or kidney disease that would put you in a high-risk category for major surgery, then a transcatheter approach might be recommended,” explains Dr. Ibrahim. “However, if you are at a low risk for surgical complications, then either type of valve replacement surgery may be an option depending on your anatomy and the condition of the valve being replaced,” he adds. “Your cardiologist will help explain the risks and benefits of each type of surgery and then make a recommendation for you. When I am going over the options with my patients, I always let them know, if this was my mom or my dad, this is what I would recommend.”
Choosing a Path Forward
While all valve surgeries share a common goal of improving your heart’s ability to circulate blood, there are some important difference between procedures, especially between mechanical valves and tissue valves. “Mechanical valves require open heart surgery and a lifetime of blood thinning medication, but they also last a lifetime,” says Dr. Ibrahim. “On the other hand, tissue valves have a much shorter lifespan, approximately 10 to 15 years, but open heart surgery is not always required, so the valve surgery may be much simpler.”
The decision for which type of valve should be used often comes down to the individual, your age, and your overall goals. “For instance, if a person is in their 50s and they are very involved in contact sports, being on a blood thinner may not be a good match for them and therefore a tissue valve would make more sense,” says Dr. Ibrahim.
Regardless of which approach you and your doctor decide on, know that you are giving your heart a new lease on life. You’ll recover sooner with some procedures: “One of the benefits of a transcatheter approach is a quicker recovery,” says Dr. Ibrahim. “After the surgery and a couple of days of rest, a patient can return to what they were doing before the surgery and hopefully will feel even better doing what they love.”
The Bottom Line on Heart Valve Surgery
There’s no way around it: Heart valve surgery sounds kind of major—because it is. But it’s also a routine procedure for cardiologists and your odds of a successful recovery trump your odds of something going wrong—and certainly trump your odds of living a full life if you do nothing at all. But don’t delay: Having surgery as soon as possible can help you avoid irreversible damage to the heart.
“What many people don’t realize is that 50% of people with severe valve disease symptoms die within two years if they are not treated,” says Dr. Ibrahim. “This means that severe valve disease can kill you quicker than most cancers.” What happens, he says, is that when your heart struggles to pump blood, it is always working. And without periods of rest, the heart begins to fail. Says Dr. Ibrahim: “Getting your heart valve disease treated in a timely manner can not only help you feel better, but it can also help you live longer.”
Understanding Heart Valves: Mayo Clinic. (2021.) “Heart valve surgery.” mayoclinic.org/tests-procedures/heart-valve-surgery/about/pac-20384901
Heart Valve Surgery: Cleveland Clinic. (2021.) “Heart valve surgery.” my.clevelandclinic.org/health/treatments/17089-heart-valve-surgery
Valve Replacement: Harvard Medical School. (2010.) “Choosing the right replacement heart valve.” health.harvard.edu/newsletter_article/choosing-the-right-replacement-heart-valve
Valve Replacement: American Heart Association. (May 2020.) “Options for heart valve replacement.” heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/options-for-heart-valve-replacement
TAVR/TAVI Procedure: American Heart Association. (May 2021.) “What is TAVR? (TAVI).” heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr