Heart valve surgery

Dr Yassir Javaid, Cardiology Clinical Director, Bupa UK
Next review due October 2022

Heart valve surgery is an operation to repair or replace leaking, narrowed or infected valves. It may ease the symptoms of heart valve disease and prevent permanent damage to your heart.

Heart valve surgery is usually open-heart surgery. This means a cut is made to the breastbone to reach the heart. However, depending on the problem and other factors, there are other procedures that may be an alternative.

About heart valve surgery

You may need heart valve surgery if there’s a problem with one or more of your heart valves. Heart valves control the blood flow in and out of your heart. Damaged or faulty valves can affect how well your heart pumps blood around your body.

Your valves may:

  • be narrow or tight (stenosis)
  • not close properly and leak (regurgitation)

Heart valve surgery can repair or replace faulty heart valves. If there’s a problem with your heart valves, you may not have any symptoms at first. You’ll usually only have surgery if your heart valves are badly damaged or causing symptoms. Heart valve surgery can ease your symptoms and improve your quantity and quality of life.

Types of heart valve surgery

Your surgeon will usually recommend repairing your damaged or faulty valves before replacing them. Both of these procedures involve surgery. Whether or not your valves can be repaired often depends on your age, what’s wrong with your valves and if you have any other medical conditions.

If your valves can’t be repaired, they’ll be replaced with prosthetic (artificial) valves. There are two main types of prosthetic valve.

  • Mechanical valves. These are made from carbon and metal and last for a very long time. If you have this type of valve, you’ll need to take blood thinning medicines (anticoagulants) for the rest of your life. This is to prevent blood clots forming on the valves.
  • Tissue (biological or bioprosthetic) valves. These are usually made from animal (pig or cow) tissue and wear out faster than mechanical valves. They are usually replaced after 10–15years. You do not need to take life-long blood-thinning medicines with this type of valve.

Your surgeon will discuss the pros and cons of each type of valve and which one is best for you.

An image showing the types of heart valve replacement

Preparing for heart valve surgery

Heart valve surgery is usually done in a specialist centre where heart surgeons work. There may not be suitable facilities locally, so you may not be able to have the surgery at your local hospital.

Before you go into hospital, you will need to prepare in advance. Many people are in hospital for about a week after surgery and it can take up to three months to fully recover at home. You won’t be able to drive for some time after your surgery, so you may need to arrange for family or friends to help with things like cooking, shopping and cleaning. If you can, it’s a good idea to stock your freezer with some pre-prepared meals. For more information, see our section: Recovering from heart valve surgery.

Your surgeon will explain how to prepare for your operation. If you smoke, you’ll be strongly advised to stop. This is because smoking increases your risk of getting a chest or wound infection, which can slow down your recovery after surgery.

You’ll have your heart valve surgery under general anaesthesia. This means you’ll be asleep during the operation. A general anaesthetic can make you sick, so you need to have an empty stomach before having a general anaesthetic. This is why it’s important that you don’t eat or drink anything before surgery. Follow your anaesthetist or surgeon’s advice and if you have any questions, just ask.

You’ll need to wear compression stockings to keep your blood flowing and to stop blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine (or tablets) as well.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed and are happy to give your consent for the operation to go ahead. You’ll be asked to do this by signing a consent form.

What are the alternatives to heart valve surgery?

If you have mild-to-moderate heart valve disease, you may well not have any symptoms and your valves and heart function will be monitored carefully.

If your heart valve problem begins to cause you symptoms, you may need to have a repair or replacement. You’ll usually have open-heart surgery, but this may depend on your overall health. If you can’t have or don’t need open-heart valve surgery, you may be able to have another procedure called transcatheter aortic valve implantation (TAVI) instead. For more information, see our sections: What happens during heart valve surgery? and Other types of heart valve procedure.

What happens during heart valve surgery?

Here we talk about what happens in open-heart surgery. You’ll have a general anaesthetic, which means you’ll be asleep during the procedure. Your surgeon will make a cut down the middle of your breastbone (sternum) to reach your heart. Your heart can’t work properly during the operation, so you’ll be linked up to bypass machine. This will make sure that blood is still pumped around your body.

There are a number of different ways to fix a faulty heart valve.

  • If your valve isn’t badly damaged, it may be possible to repair it.
  • If your valve is badly damaged, it may have to be replaced. Your surgeon may replace it with a mechanical valve or a tissue (biological or bioprosthetic) valve.

After your operation, your surgeon will join your breastbone back up using wires. They’ll then close the skin on your chest with dissolvable stitches.

Other types of heart valve procedure

You may not need to have open-heart valve surgery. Your surgeon will discuss all the available options with you. These are as follows.

  • Keyhole (minimally invasive, minimal access) surgery. Rather than make a cut in your breastbone, your surgeon will make several small cuts in your skin to open parts of your chest.
  • Percutaneous valve replacement, such as transcatheter aortic valve implantation (TAVI). Your surgeon will pass a tube through a blood vessel in your groin or neck to replace or repair your heart valve. They may offer this procedure if you’re not well enough to have open-heart valve surgery.
  • Inserting a mitral clip. This device is clipped onto a failing mitral valve in your heart to make it work better. Your surgeon can do this without cutting into your breastbone.

These types of surgery aren’t suitable for everyone. Speak to your surgeon about the best procedure for you.

What to expect afterwards

After your operation, you may be taken to the hospital’s intensive care unit (ICU) or high dependency unit (HDU). When you wake up, you’ll be connected to machines that record the activity of your heart, lungs and other body systems. You may need a ventilator machine to help you breathe. When your medical team are happy that you’re recovering safely, they’ll move you to a surgical ward.

You’ll need pain relief as the anaesthetic wears off. You may be given patient-controlled analgesia (PCA) once you wake up. A PCA pump is connected to a drip in your arm and allows you to control how much pain-relief medicine you have.

You’ll be encouraged to get out of bed and move around as soon as possible. This will help to prevent chest infections and blood clots in your legs. A physiotherapist will visit you regularly after the operation to advise you on exercises to help your recovery.

You’ll be able to go home when you and your surgeon feel you’re ready. Many people are in hospital for around a week after heart valve surgery. Make sure someone can take you home and stay with you for a day or so.

Before you go home, your nurse will give you advice about caring for your healing wounds. You may be given a date for a follow-up appointment.

If you have wires in your breastbone from the operation, these will be permanent. The dissolvable stitches your surgeon used to close your skin wound will slowly dissolve over several weeks and don’t need to be removed.

Recovering from heart valve surgery

A full recovery from heart valve surgery can take two to three months. You’ll need to build up your activities gradually to get back to normal. Everyone recovers differently, so speak to your surgeon about when you can go back to work and your other usual activities.

There’s a lot you can do to help yourself. After your surgery, your doctor may recommend you take part in a cardiac rehabilitation programme. This programme will give you advice on:

For more information, see our FAQ: Should I make lifestyle changes after my surgery?

You shouldn’t drive for at least a month after your surgery. You don’t need to tell the DVLA unless you drive a bus, coach or lorry. Don’t start driving again until you’ve checked with your surgeon first. It’s a good idea to check your motor insurance policy too.

Contact the surgical ward if you have:

  • increasing tenderness or redness round your wound
  • persistent bleeding or pus coming from your wound
  • a high temperature or fever, especially with weight loss or loss of appetite
  • new or bad heart palpitations (a sensation of a skipping or thumping heartbeat)
  • difficulty breathing
  • chest pain that’s different from the pain in your wound

Remember you’ve been through a major operation, so expect to have good days and less good days. Be kind to yourself and accept help where it’s offered. Don’t worry if progress seems slow – you’ll gradually get back to your normal activities and feel well again.

Medicines after heart valve surgery

If you have a mechanical valve replacement, you’ll need to take a blood thinning medicine (an anticoagulant, usually warfarin). You’ll need to take this for the rest of your life to stop blood clots forming around your new valve.

If you have a tissue (biological) valve replacement, you usually only need to take anticoagulant medicines for a few months after your operation.

While you’re taking anticoagulants (warfarin), you’ll need to have regular blood tests. These are important to check you’re on the right dose. Talk to your surgeon for more information about what medicines you need to take after your operation.

Side-effects of heart valve surgery

It’s normal to have some side-effects after heart surgery. These are the unwanted but mostly temporary effects that you may get after having the procedure. Everyone responds differently, but afterwards you may:

  • have a small amount of fluid leaking from your wound
  • feel some discomfort in your chest and also in your muscles such as your shoulders, back and neck
  • feel very tired
  • have a low appetite
  • feel emotional and upset, having ‘good days and less good days’
  • have trouble concentrating
  • get constipated (the painkillers you’re taking can have this effect)
  • have difficulty sleeping at night
  • notice a ticking noise in your chest if you’ve had a mechanical valve replacement (although you will have this permanently, you will get used to it)
  • have a small lump at the top of your wound, it might feel numb and itchy – this will go down and ease as it gradually heals

If you’re worried about these or any other symptoms, contact your GP.

Complications of heart valve surgery

All medical procedures carry some risks. Your surgeon will explain these to you when discussing your options with you. Complications are when problems occur during or after the procedure. Possible complications of heart valve surgery may include:

  • bleeding
  • an infection
  • blood clots
  • heart rhythm disturbances (arrhythmia)
  • problems with your kidneys
  • stroke
  • confusion

Frequently asked questions

  • If your heart valve disease was caused by coronary heart disease, it’s sensible to make lifestyle changes to stop this getting worse. Aim to:

    If you’re taking blood-thinning medicines, such as warfarin, you may need to limit how much alcohol you drink. Drinking a lot of alcohol may stop some blood-thinning medicines working so well. It’s safest not to regularly drink more than 14 units of alcohol in one week (the recommended limit), and it’s important not to binge drink. Always read the patient information leaflet that comes with your medicine carefully. If you have questions about your medicines and how alcohol may affect them, ask your pharmacist.

  • If you have a heart valve repaired and it gets infected, the infection can spread to the lining of your heart. This is called endocarditis and is a serious, potentially life-threatening condition. It’s possible for bacteria to get into your blood from your mouth when you have dental treatment. Therefore, it’s important to look after your teeth and gums and have regular check-ups with your dentist.

    Make sure your dentist knows you’ve had heart valve surgery. Doctors used to offer antibiotics to everyone at risk of endocarditis before every dental procedure. But now they don’t think this is necessary. Every situation is different though, so your dentist will discuss the pros and cons of having antibiotics before your dental work.

  • Your physiotherapist or nurse will usually help you to start moving within a couple of days after your surgery. This will help your recovery. After a few days, you can start to increase how much exercise you do. Gentle walking is the best way to start.

    Don’t do any strenuous or vigorous activity straight away as this may put a strain on your heart. If your surgeon cut through your breastbone (sternum) during your operation, don’t do any heavy lifting for around 12 weeks after surgery. This will give your bone time to heal.

    You may be offered the chance to attend a local cardiac rehabilitation centre. This will provide you with an exercise programme to make sure you’re doing the right exercises for you. Everyone’s recovery is different. Your physiotherapist, doctor or cardio rehab team will give you advice on the safest way to exercise. For more information about cardiac rehabilitation, see our section: Recovering from heart valve surgery.

    Stop exercising immediately if you feel:

    • any tightness in your chest
    • dizzy or faint
    • your heart beating irregularly
    • short of breath

    If you get any of these symptoms, stop exercising and seek medical advice.

  • Speak to your surgeon before you book any flights and check with your insurance company about your policy and cover. After open-heart surgery, it may be safe for you to fly after about 10 days. But this will depend on which type of surgery you’ve had and how well you’re recovering. You may be able to fly sooner if you have keyhole surgery or percutaneous valve replacement. If you get any complications after your surgery, such as an infection or symptoms such as chest pain, you may need to wait longer.

    When you travel, remember to carry all of your medicines in your hand luggage. Don’t carry anything heavy, so make sure you have someone to help you with your bags.

    It’s also a good idea to check with your airline for their recommendations and discuss whether you need any special arrangements.

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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, October 2019
    Expert reviewer, Dr Yassir Javaid, Cardiology Clinical Director, Bupa UK
    Next review due October 2022