Introduction
The heart has four valves that keep blood moving in one direction. A valve can leak (regurgitation) because it does not close fully, or become narrow (stenosis) and restrict blood flow.
In valve repair, the surgeon reshapes or supports the patient's own valve instead of removing it, so that it works better. Repair is most often done on the mitral valve and sometimes on the tricuspid or aortic valve.
Why the procedure is needed
A leaking or damaged valve makes the heart work harder and may cause:
- Breathlessness, particularly on effort or when lying flat
- Tiredness and reduced stamina
- Swelling of the feet or legs
- Palpitations and irregular heartbeat, including atrial fibrillation
- Enlargement and weakening of the heart over time, and heart failure if left untreated
Who may benefit
- People with a leaking valve, especially mitral regurgitation caused by degeneration of the valve
- People with symptoms, or without symptoms but with signs that the heart is beginning to enlarge or weaken
- Patients whose valve is judged suitable for repair rather than replacement
- Repair is generally not possible if the valve is too badly damaged or calcified — in which case replacement may be advised
Valve-preserving techniques
The surgeon chooses one or more techniques according to what has gone wrong with your valve.
- Annuloplasty
- A ring or band is stitched around the valve opening (annulus) to reshape it and help the leaflets close properly.
- Leaflet repair
- The valve flaps (leaflets) are trimmed, reshaped, patched or supported so that they meet and seal.
- Chordae repair
- The fine cords that hold the leaflets in position may be shortened, transferred or replaced with artificial cords.
- Commissurotomy
- In some narrowed valves, fused flaps may be gently separated to widen the opening.
- Combined techniques
- Often a combination is used; the exact method depends on the valve and what was found on echo and during surgery.
Procedure overview
Step 1: Assessment
Echocardiography (sometimes with a probe through the food pipe), angiography and other tests show how the valve is working and whether it can be repaired.
Step 2: Anaesthesia
The operation is performed under general anaesthesia.
Step 3: Surgical access
Access is usually through the breastbone, or in some centres through a smaller incision. The heart-lung machine takes over circulation while the heart is opened.
Step 4: Repair
The surgeon examines the valve directly and carries out the repair techniques needed. A test with fluid may check that the valve seals.
Step 5: Checking the result
After the heart restarts, a probe echo is often used to check the repair before closing. If the repair is not satisfactory, the surgeon may replace the valve instead.
Step 6: Recovery
After intensive-care monitoring, you recover on the ward. Follow-up echoes check the repair, and blood thinners may be needed for a period after surgery.
Clinical advantages
- Keeps your own valve, which often means no lifelong blood-thinning medicine with a mechanical valve
- Generally better preservation of heart muscle function than replacement for suitable valves, especially the mitral valve
- A repaired valve may last many years and avoid the issues of artificial valves
- May relieve breathlessness and protect the heart from further enlargement when done at the right time
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.
- General risks of open-heart surgery: bleeding, infection, rhythm problems, stroke and kidney problems
- The repair may fail or the valve may leak again over time, and a second operation or replacement is sometimes needed
- Not every valve can be repaired; the decision may only become final during the operation
- Temporary blood-thinning medicines may be needed, with their own bleeding risks
- Results depend on the type and severity of valve disease and on the experience of the surgical team
Frequently asked questions
Is repair better than replacement?
When a valve can be repaired well, repair is often preferred, particularly for the mitral valve. But it is not possible for every valve, and your surgeon will choose what is best for you.
Will I need blood-thinning medicine?
Some patients take blood thinners for a period after repair, and some longer-term. Your cardiologist will tell you what applies to you.
Can the valve leak again?
It can. That is why follow-up visits and echocardiograms are important, so that any problem is noticed early.
What if the surgeon cannot repair my valve?
If a satisfactory repair is not possible, the surgeon may replace the valve during the same operation. You will usually be asked to agree to this possibility before surgery.
How soon can I go back to normal activities?
Recovery is often around six to twelve weeks after open-heart surgery, but this varies from patient to patient.
Patient-friendly summary
Valve repair mends your own valve so that it works properly, instead of replacing it. When suitable, it can protect the heart and avoid some of the drawbacks of artificial valves, but it is not possible in every case and needs lifelong follow-up. A cardiologist and cardiothoracic surgeon can tell you whether repair is an option for you.