• Valve Repair or Replacement

    12/10/2018

    Depending on the nature and severity of your valve disease, your cardiologist may recommend one of the following procedures to repair or replace the problem valve:

    • Surgery. Surgery continues to be the most common method for repairing or replacing a valve. Learn more here.
    • Catheter-Based and Less Invasive Surgical Techniques. These treatment options are available to patients who are deemed too sick or who have other conditions that make them poor candidates for open-heart surgery. The two approaches described below address the two of the most common valve problems in the aging population: aortic stenosis and mitral regurgitation.
    • Transcatheter Aortic Valve Replacement (TAVR). TAVR is one of the new, less invasive methods for replacing the valve using a catheter. This minimally invasive procedure was formerly known as Transcatheter Aortic Valve Intervention (TAVI). Learn more here.
    • MitraClip. The MitraClip is a catheter-based approach to repairing the mitral valve. Learn more here.
    • Transcatheter Pulmonary Valve Replacement. For some types of repaired congenital heart disease, less invasive catheter-based methods to replace the valve exist.

    Repairing a Valve Problem

    In some cases, blood flow through the valve can be improved by surgically separating the valve’s leaflets or removing tissues that are obstructing the valve. Valve repair may be a good option for some patients, such as when:

    • an infant’s valve leaflets are fused together
    • a patient has tissue on or near the valve that interferes with blood flow through the valve
    • an adult’s valve is damaged to the point of causing severe narrowing or leakage

     Advantages of Valve Repair Over Replacement

    • Less risk of infection
    • Less need for life-long use of blood-thinning medication
    • The structure of the mitral valve is important to the proper functioning of the heart, so preserving the patient’s valve ultimately improves the heart function.

    The mitral valve is the most commonly repaired valve, but it is also possible to repair the aortic and tricuspid valves in certain cases, for example, for valves that have been damaged by infection. But even in this case, replacement is more common because the valve may still be deformed from scar tissue even after treating the infection and removing the dead tissue.

    Replacing a Diseased Valve

    If your valve cannot be repaired and must be replaced, your surgeon will implant one of the mechanical, manufactured, or biological valves described in the following table.

      Mechanical Valves Tissue or Biological Valves
    What are they?   • Valves manufactured from metal or carbon fiber   • Valves made from tissue taken from a cow (bovine), pig (porcine), or human cadaver (homograft or allograft) that may also have artificial parts. Also called tissue valves or bioprosthetic valves.
    Benefits   • Long-term durability   • Only have to take blood-thinning medications for the first few months after surgery.
    Risks/Disadvantages   • Blood clots, which can lead to stroke or heart attack
      • Increased risk of bleeding from taking blood-thinning medications for the rest of your life
      • May have to visit a doctor once a month to monitor levels of anticoagulation medications
      • May make a clicking noise
      • Durability is less than for a mechanical valve.

    Special Consideration for Women of Child-Bearing Age

    Although mechanical valves have long-term durability, taking some blood-thinning medications may cause birth defects, depending on when they are taken. Women of child-bearing age who are concerned about the possible risks to babies born of future pregnancies often opt for a tissue or biological valve and then, if necessary, have the valve replaced with a mechanical valve later.

    It is important to talk with your doctor to help you weigh the risks and benefits associated with each type of valve so that you choose the valve that’s right for you.