Heart Valve Surgery: Repair or Heart Valve Replacement, Good Options

Worn or leaking heart valves do not cause an emergency that a sudden heart attack does.  When you have a leaking heart valve, you will feel a range of symptoms — increasing fatigue, swollen feet and shortness of breath.  As McLeod Cardiothoracic Surgeon Michael Carmichael, MD explains, your options are clear:

Here’s a summary of Dr. Carmichael’s comments:

Heart valve problems are basically mechanical. You can’t treat regurgitation (blood leaking in the wrong direction), leaking of the valve, and blockage of the valve with medication.

You can treat some of the heart failure symptoms with fluid pills or diuretics to try to reduce the volume in the blood stream.  However, heart valve problems are surgical issues.  And there are two ways to treat it: repair or replacement.

The aortic valve you can’t repair.  (See illustration in video) It’s approximately the thickness of a butterfly’s wing. We can repair it several ways.  We can resect ruptured portions of the valve, sew it back together and then reinforce it with a ring.  One of the newer techniques is with Gore-Tex cords. We don’t respect ruptured portions of the valve; we repair it with “neo” or new cords. Then, we support that repair with a ring. It’s successful 95-96% of the time.

When we can’t repair the valve, we replace it with either a tissue valve or a mechanical valve.

People may choose a tissue valve, even though their life expectancy is greater than the longevity of the actual valve structure itself.  For example, a valve made of bovine (cow) tissue will last 25 years. Someone who is 40 years of age may want the tissue valve because they do not want to take blood thinner, which is required with a mechanical valve to avoid blood clots.

With that understanding, the operation to replace a worn out replacement aortic valve is very feasible. It doesn’t carry much more risk than the initial heart valve replacement surgery.

The TAVR procedure – Trans Aortic Valvular Replacement. (See illustration in video.) If a second aortic valve replacement is needed, we can use the transcatheter deployed valve through the old valve that has deteriorated. This can be an option for patients who have had tissue valve replacement at a younger age and their replacement have worn out.

Generally, it’s the tissue valves that might need replacement.  The mechanical valves never really wear out.  However, with a mechanical valve you would be required to take blood thinner for the remainder of your life.

To determine if you have a valve or other heart problem, find a cardiologist near you.