Heart Valve Replacement
The valves in your heart are small, but very important. They control how blood flows into and out of the heart. If they don’t work properly, it will be difficult for your heart to function as it should and your health may suffer. Some heart valve problems are congenital (present at birth), some are caused by infection or disease, and some develop as part of the aging process.
Heart valve problems are one of the things your doctor is looking for when he or she listens to your chest with a stethoscope. A murmur, a lub-dub sound, is a common tip-off that a patient may have a heart valve defect. In cases where heart valve changes have occurred over time, symptoms like fatigue or shortness of breath may be the first clue that something is amiss.
“When a heart valve needs to be repaired or replaced—whether through catheters, robotic or minimally invasive approaches, or standard open incisions—the intervention is tailored to the needs and preferences of the patient,” says Yale Medicine cardiac surgeon Matthew Williams, MD.
What are heart valves and how do they work?
The heart is made up of four chambers: two upper chambers (the left and right atria) and two lower chambers (the left and right ventricles). As the heart beats, blood moves through the heart, flowing into and out of these chambers, then passes onward to the lungs and the rest of the body.
The flow of blood through the heart is regulated by four valves. These valves ensure that blood moves only in one direction as it passes through the heart. The four valves are:
- The tricuspid valve regulates blood flow from the right atrium to the right ventricle.
- The mitral valve regulates blood flow from the left atrium to the left ventricle.
- The pulmonary valve regulates blood flow from the right ventricle to pulmonary artery (which delivers blood to the lungs).
- The aortic valve regulates blood flow from the left ventricle to the aorta. Each valve has “leaflets,” or flaps, that act like small gates. These leaflets open to let blood flow into the heart’s chambers or to the body’s arteries, and close to keep the blood from flowing backward.
What is heart valve disease?
Heart valve disease occurs when an abnormality develops in a heart valve and impairs its ability to work properly.
There are two main problems that affect the heart valves:
- Regurgitation or “leaky” valve. A defect in a valve can impair its ability to fully close. This can cause blood to regurgitate, or leak, backwards through the valve.
- Stenosis. This happens when a valve’s opening becomes narrowed, reducing the amount of blood that can flow through it.
Regurgitation and stenosis can affect any of the heart’s valves, and more than one valve can be affected at the same time. A valve can be simultaneously leaky and narrowed.
Each of these conditions interferes with the heart’s ability to pump blood around the body. They make the heart work harder than usual and can cause heart failure and other heart problems.
What are the signs and symptoms of a valve problem?
The primary sign that you have a valve problem is a heart murmur, or unusual heartbeat, that a doctor can hear when he or she listens to your heart with a stethoscope. However, having a heart murmur doesn’t necessarily mean you have a valve problem.
Other symptoms of heart valve disease include fatigue, dizziness, fainting, shortness of breath, sudden weight gain, and swelling in the ankles, neck veins, and other areas of the body.
Is surgery necessary for heart valve disease?
Some people can delay heart valve surgery with the help of lifestyle changes and medications. However, many will eventually need surgery, depending on such factors as age, health, and symptoms that are becoming severe.
What surgical options are available to repair or replace a heart valve?
Diseased and defective heart valves are often surgically repaired or replaced. Cardiac surgeons use a variety of approaches to repair or replace heart valves. A team of specialists—cardiologists, cardiac surgeons, anesthesiologists, and others—will work together to determine the best approach for your situation.
Minimally invasive techniques. In some cases, minimally invasive valve repair or replacement may be done via a catheter—a small tube—that is inserted through the skin and into a blood vessel. For instance, the aortic valve may be replaced in this manner using a technique called transcatheter aortic valve replacement, or TAVR. Similar approaches may be used to repair or replace other heart valves.
In some cases, valves are repaired or replaced using minimally invasive surgery. This involves smaller incisions and a shorter recovery period than open-heart surgery. If you are having robotic heart surgery, the surgeon will work at a video display monitor, where they can watch their progress while manipulating instruments connected to a robot.
Open-heart surgery. For some problems, open-heart surgery may be the best treatment option. This is a major surgery that involves opening the breastbone so the surgeon has direct access the heart.
Heart valve surgery typically requires general anesthesia and use of a cardiopulmonary bypass, also known as a “heart-lung machine.” This is an artificial system that circulates blood throughout the body while the heart is stopped during the procedure.
What are heart valve replacements made of?
There are two types of heart valve replacements:
Mechanical heart valves. These valves are created from man-made materials, which can be plastic or metal. Because they are considered to be the most durable, these valves are often used for younger patients. People who have a mechanical valve must take blood-thinning medications such as warfarin. They are also at higher risk for thrombosis (a blood clot). Though this is rare, it is a serious complication that is more likely to occur with a mechanical valve.
Tissue valves. While a tissue valve does not require long-term use of blood-thinners (although some patients may need them for another condition), and they are less likely to be associated with thrombosis, they are also less durable. Most will need to be replaced in 10 to 20 years. The tissue can be taken from animals or cadavers. A third option is the Ross procedure, a surgery that replaces a defective aortic valve with the patient’s own pulmonary valve. (An artificial valve replaces the pulmonary valve.)
How is Yale Medicine unique in its approach to heart valve replacement and repair?
Yale Medicine cardiac surgeons working at Yale New Haven Hospital (YNHH) have treated every type of valve disorder. More mitral valve operations and transcatheter aortic valve replacements are done at YNHH than at any other hospital in Connecticut. For patients who need it, we have a special mitral valve repair program that makes use of robotic surgery. We also offer aortic valve repair aimed at treating leaking aortic bicuspid and tricuspid aortic valves, a procedure that can be performed in conjunction with aneurysm surgery.
At the Yale New Haven Hospital Heart & Vascular Center, our cardiac surgeons and our cardiologists collaborate to determine the best options for each patient, whether it’s open heart surgery, minimally invasive surgery, or transcatheter procedures.
“Patients generally experience significant improvement in symptoms following valve surgery and should expect near normalization of their life expectancy. Yale is one of the few cardiac surgery programs in the U.S. that has three-star ratings from the Society of Thoracic Surgeons for both aortic valve and mitral valve procedures with or without concomitant coronary artery bypass procedure,” says Arnar Geirsson, MD, chief of Yale Medicine Cardiac Surgery.