Heart valve replacement surgery is performed when a damaged or diseased heart valve can no longer function properly and valve repair is not suitable or is unlikely to provide a durable result.
The procedure replaces the affected valve with a mechanical or tissue prosthesis so that blood can flow through the heart more effectively. Depending on the valve involved and your individual circumstances, replacement may be performed through conventional surgery or, in selected cases, through a catheter-based procedure.
For a broader overview of treatment options, see Heart Valve Replacement Surgery. The exact technique varies according to whether the aortic, mitral, tricuspid, or pulmonary valve is being treated. Your age, heart function, valve anatomy, overall health, surgical risk, and whether other heart procedures are needed can also influence the approach.
What Happens Before Heart Valve Replacement Surgery?
Before the procedure, your medical team performs a detailed evaluation to confirm that valve replacement is appropriate and determine which treatment approach is safest for you.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Your assessment may include:
- Echocardiography to assess the valve and heart function
- Electrocardiography to evaluate heart rhythm
- Blood tests
- Imaging of the heart and blood vessels when required
- Assessment of other medical conditions
- Evaluation of surgical or procedural risk
Step-by-Step: How Surgical Valve Replacement Is Performed
Traditional surgical valve replacement is performed in an operating room under general anesthesia. While the details vary between valve types, the procedure generally follows several stages.
1. General anesthesia is administered
You are given general anesthesia so that you remain unconscious and do not feel the operation. You are connected to monitoring equipment that continuously tracks your heart rhythm, blood pressure, oxygen levels, and other vital functions.
2. The surgeon gains access to the heart
In conventional open-heart surgery, the surgeon usually accesses the heart through an incision in the chest. The breastbone may be opened to provide sufficient access to the heart and the affected valve.
In selected patients, a minimally invasive surgical approach may be possible. This uses smaller incisions and is not appropriate for every patient or every type of valve procedure.
3. A heart-lung bypass machine may be used
During many conventional valve replacement operations, a heart-lung bypass machine temporarily takes over the work of the heart and lungs. It keeps blood circulating through the body and supplies it with oxygen while the surgeon operates on the heart.
This allows the surgical team to work on the valve in a controlled environment. The exact method of managing the heart during surgery depends on the procedure being performed.
4. The damaged valve is exposed
The surgeon carefully reaches the affected valve. The surgical route differs depending on whether the aortic, mitral, tricuspid, or pulmonary valve is being replaced. The valve and surrounding structures are assessed before the diseased valve is removed or prepared for replacement.
5. The diseased valve is removed or prepared
When surgical replacement is required, the damaged valve is removed or the affected valve structures are prepared to accommodate the replacement prosthesis.
The technique is different for each valve because the anatomy and surrounding structures are not the same. The surgeon takes care to preserve important surrounding tissues whenever possible.
6. The replacement valve is positioned
The replacement valve is then placed in the appropriate position and secured to the surrounding tissue. The replacement can be a mechanical valve or a tissue valve.
Mechanical valves are made from durable artificial materials, while tissue valves are made from biological tissue. The choice is made before surgery after considering factors such as age, valve position, expected longevity, anticoagulation requirements, bleeding risk, pregnancy considerations, and personal preferences.
7. The new valve is checked
After the replacement valve has been secured, the surgical team checks its position and function. Imaging and other monitoring techniques may be used to assess valve movement and blood flow through the new valve.
The team also checks for any significant leakage around the prosthesis and confirms that the valve is functioning as expected before completing the operation.
8. Normal circulation is restored
Once the surgical team is satisfied with the valve's function, normal circulation is gradually restored and the heart-lung bypass machine is withdrawn when appropriate. The heart's rhythm and function are closely monitored as the heart resumes its normal workload.
9. The surgical incision is closed
After the procedure is completed, the chest is closed. In conventional surgery involving the breastbone, it is secured so that it can heal during recovery. You are then transferred for close postoperative monitoring.
How Is Aortic Valve Replacement Performed?
Aortic valve replacement can be performed surgically or, in selected patients, through a catheter-based procedure. During surgical aortic valve replacement, the surgeon accesses the aortic valve, removes or prepares the diseased valve, and secures the replacement prosthesis in its place.
For suitable patients with aortic valve disease, transcatheter aortic valve implantation or replacement (TAVI/TAVR) may provide an alternative to conventional surgery.
How Is TAVR/TAVI Performed?
TAVR or TAVI is different from conventional surgical valve replacement because the new valve is delivered through a catheter rather than through open-heart surgery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
A catheter is usually introduced through a blood vessel, commonly in the groin, and guided toward the heart. The replacement valve is mounted on the catheter and positioned within the diseased aortic valve.
Once correctly positioned, the replacement valve is expanded or deployed. It pushes the diseased valve leaflets aside and begins regulating blood flow through the aortic valve.
The procedure does not involve surgically removing the native aortic valve in the same way as conventional surgical replacement.
TAVR is not suitable for everyone. Detailed imaging is used to determine whether the patient's valve anatomy and blood-vessel access are appropriate.
How Is Mitral Valve Replacement Performed?
Mitral valve replacement is usually performed surgically when the mitral valve is severely diseased and cannot be repaired effectively.
The surgeon accesses the mitral valve, removes or prepares the damaged valve, and secures the replacement valve in the mitral position. The surrounding heart structures are carefully preserved where possible because of the complex anatomy around the mitral valve.
In selected patients who have severe mitral valve disease and are not suitable for conventional surgery, certain catheter-based treatments may be considered. The appropriate approach depends on the type of mitral valve disease and the patient's anatomy.
What Happens Immediately After the Operation?
After surgical valve replacement, you are usually transferred to an intensive care setting or another closely monitored area. Your heart rhythm, blood pressure, breathing, oxygen levels, and other vital functions are monitored closely.
Immediately after surgery, you may have temporary tubes and monitoring lines. These can include a breathing tube, chest drainage tubes, intravenous lines, and a urinary catheter. They are generally removed as your condition becomes more stable.
Once you are awake and medically stable, the team gradually encourages breathing exercises, eating and drinking, sitting up, and walking. Activity is increased progressively according to your recovery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Determines How the Valve Replacement Is Performed?
The treatment approach is individualized. Your medical team may consider:
- The valve that needs treatment
- The severity and type of valve disease
- Your age and expected life expectancy
- Heart function
- Your overall health and other medical conditions
- Your surgical risk
- The anatomy of the heart and blood vessels
- Whether additional cardiac surgery is required
- The type of replacement valve selected
- Your preferences and long-term treatment goals
What Are the Main Risks of Heart Valve Replacement Surgery?
Like other major heart procedures, valve replacement carries potential risks. The specific risks vary according to the procedure and the patient's health.
Possible complications can include bleeding, infection, abnormal heart rhythms, blood clots, stroke, kidney problems, complications related to anesthesia, or problems involving the replacement valve.
Some patients may also require a pacemaker or another procedure depending on the type of valve treatment and complications that occur.
The Bottom Line
Heart valve replacement involves several carefully planned stages, from preoperative evaluation and anesthesia to accessing the heart, treating the damaged valve, placing the replacement, checking its function, and monitoring recovery.
Traditional surgical replacement remains an important treatment for many patients, while catheter-based procedures such as TAVR/TAVI can provide an alternative for selected patients with aortic valve disease. The appropriate approach depends on the affected valve, your anatomy, overall health, surgical risk, life expectancy, and long-term treatment goals.
Understanding how the procedure is performed can help you prepare for treatment and have a clearer discussion with your medical team about the approach recommended for your particular valve condition.
