Introduction
When a heart valve is too damaged to repair, the surgeon may remove it and replace it with an artificial valve. This is most often done for the aortic or mitral valve, and sometimes for the tricuspid or pulmonary valve.
The new valve opens and closes with each heartbeat to keep blood flowing in one direction, relieving the strain on the heart caused by a narrowed or leaking valve.
Why the procedure is needed
A severely narrowed or leaking valve can cause:
- Breathlessness on effort or at rest
- Chest pain or tightness
- Dizziness or fainting, especially with a narrowed aortic valve
- Tiredness, reduced stamina and swollen feet
- Heart enlargement, heart failure or rhythm problems if left untreated
Who may benefit
- People with severe valve narrowing or leakage who have symptoms
- People who have no symptoms but whose tests show that the heart is being damaged
- Patients whose valve cannot be repaired — for example because it is heavily calcified or destroyed by infection or rheumatic disease
- Patients in whom the heart team judges replacement to be the safest and most effective option
Mechanical and biological valves
The type of valve is chosen together with you, according to your age, lifestyle, other health conditions and ability to take and monitor medicines.
- Mechanical valve
- Made of durable materials and designed to last for a very long time. It needs lifelong blood-thinning medicine (such as warfarin) with regular blood tests (INR) to prevent clots. Pregnancy planning needs special care.
- Biological (tissue) valve
- Made from animal tissue. It generally needs blood thinners only for a limited period, but it may wear out over time — often in ten to twenty years or sometimes sooner — and may need to be replaced again.
- Medicines
- Mechanical valves need lifelong anticoagulants; biological valves usually do not, unless there is another reason such as an irregular heartbeat.
- Follow-up
- Both types need regular check-ups and echocardiograms. Antibiotic cover before certain dental or surgical procedures may be advised to prevent infection of the valve.
- Choosing between them
- Younger patients are often advised mechanical valves if they can take blood thinners reliably; older patients or those who cannot take blood thinners are often advised biological valves. This is a joint decision with your surgeon.
Procedure overview
Step 1: Planning
Echocardiography, angiography and other tests show the valve and the heart. You discuss the valve type with your surgeon.
Step 2: Anaesthesia
General anaesthesia is used.
Step 3: Surgical access
The chest is usually opened through the breastbone, although smaller incisions may be suitable for some patients. The heart-lung machine takes over circulation.
Step 4: Removing and replacing the valve
The diseased valve is removed, and the new valve is stitched firmly into place. Other problems, such as a coronary blockage, may be treated in the same operation.
Step 5: Restarting the heart
The heart is restarted, the valve is checked, and the machine is gradually stopped.
Step 6: Recovery
You are monitored in intensive care and then on the ward. Blood-thinning treatment is started and adjusted. Full recovery typically takes several weeks to a few months.
Clinical advantages
- May relieve breathlessness, chest pain, dizziness and tiredness
- May protect the heart from further damage and improve how long and how well people live, in suitable patients
- Mechanical valves are designed to last very long; biological valves avoid long-term blood thinners for many patients
- Can allow a return to normal daily activities for many patients
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
- Mechanical valves: blood clots on the valve if medicine is missed, and bleeding from blood thinners
- Biological valves: gradual wear, which may need another operation or procedure later
- Infection of the valve (endocarditis), which needs prompt treatment
- Valve leaks around the new valve, or a need for a pacemaker in a small number of patients
- Risk depends on your age, heart function and other illnesses
Frequently asked questions
Which is better — a mechanical or a biological valve?
Neither is better for everyone. Mechanical valves last longer but need lifelong blood-thinning medicine. Biological valves usually avoid that but may wear out. Your surgeon will help you choose based on your age, health and lifestyle.
Will I need medicines for life?
With a mechanical valve, yes, you will need a blood-thinning medicine for life. With a biological valve, usually only for a few months unless there is another reason. Never stop or change these medicines without your doctor's advice.
How long does a new valve last?
Mechanical valves are made to last a lifetime. Biological valves often last ten to twenty years, but this varies. Regular follow-up shows how your valve is doing.
Can I get pregnant with a mechanical valve?
Pregnancy is possible but needs careful planning with your cardiologist, because the blood thinners can affect the baby. Discuss this before surgery.
Will I need antibiotics before dental work?
Your doctor may advise antibiotic cover before certain dental procedures to protect the valve from infection. Good dental hygiene is also important.
Patient-friendly summary
Valve replacement removes a badly diseased valve and puts in a mechanical or biological one. It can relieve symptoms and protect the heart, but each valve type has its own medicine needs, durability and risks. Choosing the right valve, and lifelong follow-up, are decisions to make with a cardiologist and cardiothoracic surgeon.