Valve Repair / Replacement

Pathway of blood flow through the various chambers and valves in the heart.

To repair or replace damaged valves

Valve repair (also called valvuloplasty) is a procedure whereby the surgeon fixes a faulty valve. The mitral valve is the most commonly repaired valve, but the aortic and tricuspid valves may also undergo some of these repair techniques. During surgical repair of valve defects, such as mitral incompetency, the surgeon reconstructs the valve so that it can close properly, which can include:

• Fixing holes in a valve
• Reconnecting valve leaflets 
• Separating valve leaflets that have fused together
• Removing excess valve tissue 
• Replacing chords supporting the valve 
• Strengthening and tightening the valve with a synthetic ring 

It is important to note that valve repair is only suitable for selected patients. If the valve is severely damaged, replacement of the valve will be necessary. In valve replacement surgery, the patient’s heart valve is replaced by an artificial valve which can be made of metal (mechanical valve), or biologic animal tissue (bio-prosthetic valve). The following shows the advantages and disadvantages of mechanical and bio-prosthetic valves respectively:

Type of Valve	Advantage	Disadvantage
Mechanical valves	Can last for 30 years or more.	May cause blood clots and hence, patients with mechanical valves need to take lifelong anticoagulation medication.
Bio-prosthetic valves	Do not cause blood clots and hence, patients with bio-prosthetic valves do not need to take anticoagulation medication.	Only last an average of 10 years and need to be replaced when they wear out.

Your doctor will make recommendations based on the severity of your condition and medical history.  

How is a valve repair or replacement done?

Valve repair surgery is typically done though open-heart surgery.

Traditionally, heart valve surgery is conducted through open-heart surgery via a median sternotomy, which involves splitting the sternum (breastbone). As such, the patient will be given general anaesthesia before the surgeon cuts open the chest. The patient will then be connected to the heart-lung bypass machine which performs the heart’s pumping functions. 

A Transesophageal Echocardiogram (TEE) is conducted to monitor the functions of the patient’s valves both before and after the procedure. An echo probe will be inserted down the oesophagus which is behind the heart and thus should not interfere with the surgery. 

One or more plastic chest drains may be left in the chest to drain any excess fluid. Pacing wires may be left in the heart temporarily to control the heart rhythm when necessary. The breastbone is then wired together and wounds are closed with absorbable sutures. 

Percutaneous transcatheter valve repair or replacement techniques

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Preparation for valve repair or replacement 

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After a valve repair or replacement surgery

Recovering from valve repair or replacement surgery 

1) Engage in light physical activity

You can start with light activities such as doing chores and taking strolls. This can be beneficial to patients who face difficulties with sleeping after the surgery. However, within the first two months, you should avoid:

• Lifting, pushing or pulling heavy objects (depending on your level of fitness)
• Driving a car  
  

If it is possible, patients going back to work should start with reduced working hours and workloads before gradually increasing these back to normal. This prevents excessive strain on the body.

2) Care for your wound(s)

Keep the wounds and the surrounding areas dry. Clean the wound using soap and warm water only. Please visit your doctor immediately if you notice any signs of infection such as:

• Pus 
• Fever more than 38º C
• Tenderness and redness around the wound(s)
• Opening up of the wound(s)

3) Take note of cognitive and emotional changes

Patients might experience slight decreases in their cognitive functions though this is usually temporary. To cope with this, patients should avoid any stressful or mentally taxing tasks within the first few weeks of surgery. 

Some patients might also experience an onset of low moods or even depression after the surgery. However, patients’ moods should generally improve over the period of recovery. Patients could also speak with their family and friends to cope with these emotions. 

Cardiovascular Rehabilitation & Preventive Cardiology (CVR & PC) Programme

Cardiac Rehab Programme

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Alternatives to valve repair or replacement 

For patients who are unfit for surgery, there are alternatives such as: