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Heart Valve Repair and Replacement

The heart has four valves: The aortic, mitral, pulmonary and tricuspid valves. Valves work as one-way doors that guide blood from the body, through the heart, to the lungs and back out to the body. Each valve, made of thin but strong tissue that is attached to the heart muscle by a flexible hinge called an annulus, opens and closes with every beat of the heart.

The aortic valve separates the left ventricle and aorta. The aorta valve controls flow of oxygen-rich blood from the heart to the body.

The mitral valve separates the left atrium and left ventricle. This valve takes oxygen-rich blood from the lungs and pulmonary artery and pumps it into the left ventricle. From the left ventricle, the blood is pumped through the aortic valve and out to the body.

The pulmonary valve is the smallest of all valves and separates the pulmonary artery and the right ventricle. The pulmonary valve controls blood flow from the right ventricle to the pulmonary artery, where blood exchanges carbon monoxide for oxygen before it is returned to the left atrium and is pumped out to the body.

The tricuspid valve separates the right atrium and right ventricle. The tricuspid valve controls the blood flow of deoxygenated blood used by the body and collected in the right atrium to the right ventricle. It is from this point that the blood is returned to the heart for oxygen and then returned to the body.

Great advances have been made in recent years pertaining to heart valve repair and replacement surgery. The surgeons and staff of Norton Heart Care are well prepared to offer you the care you need to treat heart valve disease. Repair procedures often are performed on valves. The mitral valve is especially suited to reparative techniques. Repair of a stenotic valve often involves cutting or separating the valve leaflets to widen the valve opening. Repair of an insufficient valve often is achieved by narrowing or shortening the supporting structures that allow the valve to close. Repair techniques also may include the use of a variety of prosthetic rings to reshape deformed valves.

In addition to the surgical procedures, percutaneous balloon valvuloplasty is a nonsurgical procedure for heart valve stenosis. With this procedure, surgeons thread a balloon-tipped catheter through a large artery into the narrowed valve opening. The balloon is inflated, thereby enlarging the valve opening.

A heart valve replacement may be performed when a diseased valve cannot be repaired. The valve is removed and replaced with a substitute mechanical or biological valve.

Mechanical valves
Mechanical valves are constructed of durable materials that work in place of the original valve and usually last a lifetime. Mechanical valves require the long-term use of anticoagulation medication to prevent formation of blood clots in the heart.

Biological valves
Biological valves are made of tissue taken from pigs, cows or human donors and often do not require anticoagulation medication.  However, they generally do not last as long as mechanical valves. Biological valves are recommended for elderly patients or for individuals with bleeding disorders.
One form of biological valve replacement is accomplished with autografts. Autografts refer to tissue from the patient's own body. Tissue is removed from one location and placed in another location. This procedure may be performed when the surgeon decides that using the patient's own tissue for the surgery will achieve the most effective outcome.

What to expect during this procedure

  • Pre-admission testing may be required prior to your surgery. This consists of multiple tests that will help your care team and surgeons prepare to care for you during and after surgery.
  • The day of your surgery, you will be asked to arrive at the hospital several hours before your surgery. Please be sure to follow all pre-surgery instructions.
  • Prior to your surgery, you will be taken back to the hospital's pre-surgery area, where you will be prepped for surgery. Some tests will be performed, an IV will be started and other preparations will be made. You will be asked to change into a gown and remove all jewelry. Your family and friends will be asked to wait in the hospital's surgery family room.
  • Members of your surgery team, including your cardiovascular surgeon and anesthesiologist, will meet with you prior to surgery to answer any questions.
  • You will be transported from the pre-surgery area to the operating room, and an anesthesiologist will give you medication to help you sleep.
  • During heart valve surgery, a surgeon makes an incision down the center of your chest, cuts through your breastbone and retracts your ribcage to get direct access to your heart.
  • You will be connected to a heart-lung bypass machine, which circulates blood throughout your body in place of your heart and lungs during surgery.
  • Your heart is stopped, and your surgeon performs the valve surgery. Surgery time and complexity will be determined by the type of valve repair or replacement performed.
  • Once surgery is complete, your surgeon will close your breastbone with special sternal wires and your incision with special internal and/or external stitches. The surgeon will use electrical shocks to re-start your heart, and you will be removed from the heart-lung bypass machine. Pacing wires and a chest tube to drain fluid will be placed in your chest before it is closed completely. Sometimes a temporary pacemaker is attached to pacing wires to regulate your heart rhythm until your condition improves.
  • Members of your surgical team will update your family and friends on your condition and results from surgery.

What to expect after this procedure

  • You will be transferred to the hospital's open-heart unit for monitoring. The open-heart unit is a special intensive care unit staffed with specially trained intensive care nurses and staff.
  • Your health and progress will be continuously monitored and you will be on a respirator. Monitoring includes frequent checks of your vital signs, heart sounds, blood oxygen and carbon dioxide levels.
  • As your health improves, you eventually will be taken off the respirator and some monitors. Patients typically stay in the open-heart unit for two to three days after surgery.
  • You will be transferred to a step-down unit, sometimes called the progressive heart unit, and will remain in the hospital for three to seven days of additional monitoring after your time in the open-heart unit.

Returning home

  • Full recovery from surgery may take two to three months or longer depending on the specific procedure. Most patients are able to drive three to eight weeks after surgery. Sexual activity can be resumed in three to four weeks, depending on your rate of recovery.
  • Most people with jobs that require little physical exertion can start back to work four to six weeks after surgery. If your job is physically demanding (such as construction work or heavy lifting), you may have to wait up to 12 weeks or longer before returning.
  • Your surgeon and cardiologist will schedule multiple follow-up visits with you after surgery and will work with you to develop a recovery plan. Often, cardiac rehabilitation is recommended by your physician to help you regain strength and energy and encourage healthy lifestyle changes. Lifestyle changes are important, including quitting smoking, exercising regularly, managing weight, treating high cholesterol, controlling diabetes and high blood pressure, improving your diet, taking prescribed medications and following up with your doctor for regular visits.
    If you have any questions about your care after you return home, call your physician's office.

This procedure is offered at these facilities:

To find a physician visit our Find a Doc or call (502) 629-1234 for a physician referral.

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