Before your surgery, you will receive general anesthesia. You will be asleep and unable to feel pain.
In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.
Minimally invasive valve surgery is done using several small cuts. It can also be done through a catheter inserted through the skin. Methods include:
The surgeon may be able to repair your valve using one of the following procedures:
Ring annuloplasty. The surgeon repairs the valve by sewing a ring of metal, plastic, cloth, or tissue around the valve.
Valve repair. The surgeon trims, shapes, or rebuilds one or more of the flaps that open and close the valve (leaflets). Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.
If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one in place.
The main types of new valves are:
Mechanical: Valves are made of man-made materials, such as metal (stainless steel or titanium) and a special form of carbon. These valves last an average of 8 to 20 years. You will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
Biological: Valves are made of human or animal tissue. These valves last 12 to 15 years. You may not need to take blood thinners for life with biological valves.
In some cases, surgeons can use your own pulmonary valve to replace the damaged aortic valve. The pulmonary valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure is ideal for people who do not want to take blood thinners for the rest of their life.
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patiens with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.
Bernstein D. General principles of treatment of congenital heart disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.
Matthew M. Cooper, MD, FACS, Cardiovascular & Thoracic Surgery; Medical Director, CareCore National, Bluffton, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.