In many cases, the best treatment option for a diseased heart valve is to surgically replace or repair the valve.

As with any surgery, there may be general risks of infection, reaction to anesthesia or bleeding. Other risks specific to heart valve surgery may include abnormal heart rhythms, valve leakage, blood clots, stroke and heart failure. Keep in mind, however, that potential risks from heart valve disease may be greater than risks with surgery. Without appropriate treatment, your valve disease may progress to more severe symptoms, damage your heart, or result in early mortality. With successful valve surgery, you can expect a normal or near-normal life expectancy. The procedure is straightforward and historically has had high success rates and low risks of complications.

Heart Valve Replacement Surgery

Heart valve replacement surgery usually requires an open-heart procedure, lasting approximately 2-5 hours. A brief summary of what to expect from surgery follows but your cardiac surgery team will provide you with more detailed information.

Step 1. Preparation before surgery

You will be asked to not eat any food for up to 12 hours before the procedure to minimize potential reactions to the anesthesia. You also may be asked to temporarily stop taking some or all of your medications.

Once in the operating room, you will be monitored for heart function and other vital signs. An intravenous (IV) line into your arm will deliver fluids and medications. Your chest will be shaved (if necessary), sterilized, and covered with sterile drapes.

You will be put under general anesthesia and placed on a respirator to help you breathe during the procedure. A transesophageal echocardiogram (an ultrasound device) may be inserted into your esophagus to display images of your heart during the surgery.

Step 2. Open the chest

Your surgeon will make an incision in your chest, usually down the middle.

Step 3. Begin heart-lung bypass

When your heart is visible, your cardiac surgeon will place you on heart-lung bypass, necessary to stop your heart from beating so your surgeon can more easily perform the procedure, keep oxygen-rich blood circulating throughout your body while your heart is stopped and reduce the risk of hemorrhage.

Step 4. Inspect the damaged valve

Your surgeon will make an incision to expose your diseased valve and evaluate the extent of damage. This will help your surgeon determine whether a heart valve replacement or repair should be performed.

Step 5. Remove the diseased valve

If valve replacement is necessary, your surgeon will remove the diseased valve and measure the valve opening to select a proper size for the replacement.

Step 6. Insert the new valve

After final checking for proper fit and aligning the replacement valve for optimal blood flow, your surgeon will suture the new valve to the annulus (the ring of tissue that supports valve leaflets) of your natural valve, ensuring there are no leaks, excess sutures, or other issues that may present problems later.

Step 7. Remove heart-lung bypass

Your surgeon will follow the recommended protocol for stopping heart-lung bypass and then evaluate your heart and valve function on their own.

Step 8. Close the chest

A tube may be placed in your chest for a few days to remove excess fluids during the healing process.  Temporary pacemaker wires may also be inserted just in case they are needed. Your chest will be then closed and your incision secured shut.

Step 9. Post-surgery monitoring

After the surgery, you will be taken to the intensive care unit (ICU) and your heart function and other vital signs will be monitored as you wake up from the anesthesia. Your breathing tube will be removed. After 1-3 days in the ICU, you will be transferred to a regular hospital room to continue your recovery.

After the Surgery

Your hospital stay after open-heart surgery will be approximately 4-5 days but may be longer, or shorter. While still in the hospital, your condition will continue to be monitored. You will begin walking soon after the surgery and receive instructions on post-op care, cardiac rehabilitation, lifestyle changes, and other important information.

You may be prescribed medications, such as anticoagulants, aspirin, and heart rhythm medications.

Long-term Follow-up

Once you have recovered from open-heart surgery (usually in 4-8 weeks), keep in mind some general guidelines for maintaining your health:

  • Keep all follow-up appointments with your health care providers.
  • Follow your physician’s advice about diet, exercise, losing weight, and other lifestyle changes.
  • Report a return of symptoms (e.g., shortness of breath, excessive fatigue) or any new symptoms to your physician immediately.
  • Always go to your physician and other health care providers with questions or concerns you may have.
  • Take care before any dental or other invasive procedure. Your physician may advise you to take antibiotics before and after the procedure to prevent bacterial infections in your heart (endocarditis).
  • Tell all of your health care providers that you have had a heart valve replacement or repair.
  • Carry your patient identification card with you at all times. You may also want to consider a medical alert bracelet or other identifying jewelry.
  • If you are taking anticoagulants, follow your physician’s instructions for dosing, monitoring, and precautions to take with these medications.