How a heart valve replacement is done

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