Heart Valve Replacement

A heart valve that no longer opens or closes properly forces the heart to work against a load it was not designed for, and over time the muscle thickens or stretches in response. Replacement removes the damaged valve and sews a new one into its place.

There are two kinds of replacement valve and the choice is genuinely yours to make with your surgeon. A mechanical valve is made of carbon and metal and lasts a lifetime, but the body forms clots on it, so it requires blood-thinning medication every day for life with regular blood tests to keep the level in range. A tissue valve, made from treated animal tissue, needs no long-term blood thinner in most people, but it wears out over time and may need replacing, sooner in younger patients and later in older ones. Age, plans for pregnancy, ability to attend for regular testing, bleeding risk and your own preferences all enter the decision.

Repairing a valve is better than replacing it where it is possible, and it is possible more often for the mitral valve than the aortic. For some people, particularly older patients and those for whom open surgery is high risk, a valve can be placed through a catheter from an artery in the groin without opening the chest; whether that applies to you is decided by a heart team from your scans and your overall condition.

You are admitted a day or two beforehand for blood tests, cross-matching, a dental check and an antiseptic wash. Dental treatment is completed before valve surgery because bacteria from the mouth can settle on a new valve.

The operation is under a general anaesthetic. The chest is usually opened through the breastbone, though some valves are reached through a smaller cut between the ribs or a partial division of the breastbone. You are placed on the heart-lung bypass machine, which circulates and oxygenates your blood so the heart can be stopped while the old valve is removed and the new one stitched in. The operation takes three to five hours.

You wake in intensive care on a breathing machine for a few hours, with chest drains, lines and temporary pacing wires attached to the surface of the heart. Drains and wires come out over the following days. You sit out on the first day, walk on the second, and move to the ward after a day or two. A stay of seven to ten days is usual.

The breastbone takes six to eight weeks to heal and governs the first two months. Nothing heavier than two to three kilograms lifted, pushed or pulled, no driving for four to six weeks, and roll onto your side to get out of bed. Breathing exercises every hour while awake in the early weeks.

Expect tiredness that is out of proportion to the day, disturbed sleep and low mood for several weeks; this is usual after heart surgery and it passes. Desk work restarts at eight to twelve weeks, physical work later. Cardiac rehabilitation is the structured way back to exercise and is worth asking to be referred to.

If you have a mechanical valve, the blood-thinning medication starts in hospital and is lifelong. The blood test that measures its effect is done frequently at first and then every few weeks, the target range is specific to your valve and its position, and many foods and medicines shift the result. Learn what affects it and carry a card saying which valve you have.

Tell every dentist and doctor that you have a replacement valve. You will need antibiotics before certain dental and surgical procedures, for life, to protect the valve from infection.