Introduction
Sometimes two heart valves are damaged at the same time — most often the aortic and mitral valves, commonly after rheumatic heart disease. In double valve replacement, both diseased valves are removed and replaced during the same operation.
Treating both valves together spares the patient two separate major operations, although it is a bigger operation than replacing a single valve.
Why the procedure is needed
Two diseased valves put a heavy strain on the heart and may cause:
- Marked breathlessness, even with little effort
- Tiredness, reduced stamina and swollen feet
- Chest pain, dizziness or fainting
- Palpitations and irregular heartbeat such as atrial fibrillation
- Heart enlargement and heart failure if not treated
Who may benefit
- People with severe disease of two valves, often due to rheumatic heart disease
- Patients with symptoms, or in whom tests show the heart is being damaged, and whose valves cannot be repaired
- Patients in whom the heart team judges that treating both valves together is safer than treating them one by one
- Suitability depends on heart function, age, other illnesses and the condition of the valves
Valve options, recovery and monitoring
- Valve choices
- Each of the two valves can be a mechanical or a biological one. Often the same type is used for both so that medicine needs are simple, but your surgeon may advise otherwise.
- Medicines
- If at least one valve is mechanical, lifelong blood-thinning medicine and regular INR tests are needed. Biological valves alone usually need blood thinners for a limited time unless there is another reason.
- Rhythm problems
- Atrial fibrillation is common with valve disease; it may need rhythm treatment or blood thinners even with biological valves.
- Recovery
- Recovery is generally longer than after single-valve surgery. Hospital stay and rehabilitation are planned around your progress.
- Monitoring
- You will need lifelong follow-up with regular echocardiograms, blood tests where applicable and medicine reviews.
Procedure overview
Step 1: Planning
Echocardiography and angiography show both valves and the heart. You discuss valve types, medicines and timing with your surgeon.
Step 2: Anaesthesia
General anaesthesia is used, with detailed monitoring of the heart and circulation.
Step 3: Surgical access
The chest is usually opened through the breastbone. The heart-lung machine takes over circulation.
Step 4: Replacing the valves
The two diseased valves are removed and the new valves are stitched in. Other problems, such as a coronary blockage or tricuspid valve leakage, may be treated at the same time.
Step 5: Restarting the heart
The heart is restarted, both valves are checked, and the heart-lung machine is gradually stopped.
Step 6: Intensive care and recovery
You are monitored closely in intensive care and then on the ward. Blood-thinning treatment is started, and a rehabilitation plan is made.
Clinical advantages
- Treats both valve problems in one operation, avoiding a second major surgery
- May relieve breathlessness, tiredness and swelling and improve the ability to be active
- May protect the heart from further damage when done at the right time
- Allows the heart to work more efficiently with two properly working valves
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- The risks of open-heart surgery — bleeding, infection, rhythm problems, stroke and kidney problems — may be somewhat higher than for single-valve surgery
- Mechanical valves: clots if medicines are missed, and bleeding from blood thinners
- Biological valves: gradual wear, which may mean another procedure later
- Possible need for a pacemaker after surgery in a small number of patients
- Infection of the valves (endocarditis), which needs prompt treatment
- Risk depends greatly on heart function, age, kidney and lung health and other illnesses
Frequently asked questions
Why are both valves replaced at the same time?
If both are badly damaged, treating them together avoids a second major operation later. Your surgeon decides this after looking at your tests.
Is DVR a bigger operation than single valve surgery?
Generally yes. It takes longer and the risks may be somewhat higher, so the heart team weighs the benefits carefully for each patient.
Will I need blood thinners for life?
If you receive a mechanical valve, yes. With only biological valves, usually only for a limited time, unless you also have another reason such as atrial fibrillation.
How long is the recovery?
Many patients stay in hospital about a week or more, and recovery often takes two to three months. It varies from patient to patient.
What follow-up will I need?
Regular visits, echocardiograms and, if you have a mechanical valve, regular INR blood tests. Report fever, new breathlessness or unusual bleeding promptly.
Patient-friendly summary
Double valve replacement treats two diseased heart valves in a single operation. It is a larger operation with more risk than single-valve surgery, but it can relieve symptoms and protect the heart when both valves are badly damaged. The choice of valves, medicines and follow-up should be decided with a cardiologist and cardiothoracic surgeon.