Heart Valve Repair and Replacement Overview

Introduction To Heart Valve Surgery

If you are scheduled for heart valve repair or heart valve replacement surgery at Brigham and Women's Hospital, you can expect to receive the highest quality of skill and care available anywhere.

Every year, our cardiac surgeons perform more than 600 heart valve operations, including "minimally invasive" procedures. In addition to experienced surgeons at Brigham and Women's Hospital, you will be well cared for by a collaborative team of nurses, physician assistants, physical therapists and social workers. It's no wonder that U.S. News & World Report consistently ranks Brigham and Women's Hospital as a top hospital for heart and vascular.

Your Heart/Heart Valves

Your heart is a pumping muscle responsible for circulating oxygen-rich blood throughout your body. There are four chambers inside your heart: the two upper chambers are called atria and the two lower chambers are called ventricles. The heart muscle squeezes blood from chamber to chamber.

Your heart contains four valves, which open to allow blood to move forward through the heart and close to prevent blood from flowing backward.

• The mitral valve allows blood to move from the left atrium into the left ventricle.
• The aortic valve allows blood to move out of the left ventricle.
• The tricuspid valve allows blood to move from the right atrium into the right ventricle.
• The pulmonary valve allows blood to move from the right ventricle to the lungs.

Heart Valve Disease

Heart valves can be abnormally formed as birth defects or damaged by rheumatic fever, bacterial infection, and calcific degeneration. Valves can also degenerate with the normal aging process.

Two common types of valve disease are:

• Stenosis, which occurs when a valve does not open completely, causing blood to flow through a narrower opening.
• Regurgitation, which results when a valve does not close completely, allowing blood to flow backward through the valve.

To compensate for these disorders, your heart pumps harder, which can result in inadequate blood circulation to the rest of your body.

In addition, this excess work can weaken the heart, causing it to enlarge and produce the following symptoms:

• Increased shortness of breath
• Chest pain
• Swelling of the ankles and legs
• Increased fatigue
• Dizziness
• Fainting

Cardiovascular Diagnostic tests

To diagnose and determine treatment for your particular valve disease, your doctor will obtain a complete medical history, perform a thorough physical exam and order any or all of the following special diagnostic tests:

• Chest x-ray — X-rays can provide doctors information about the size of your heart and its four chambers, as well as information about your lungs.
• Electrocardiogram (EKG) — This test records the changes of electrical activity occurring during your heartbeat. It helps to diagnose any irregularities in your heart's rate and rhythm, as well as in heart muscle enlargement or damage.
• Echocardiogram (echo) — This test uses ultrasound to examine and measure the structure of your heart. An echo demonstrates performance of the heart valves and provides information on heart muscle function.
• Cardiac catheterization (coronary arteriogram) — This test allows visualization of your blood vessels and measurement of pressures inside your heart chambers following injection of a contrast dye. An angiogram evaluates heart pumping function and any obstruction of the coronary arteries that supply blood to your heart muscle. If your coronary arteries have significant blockages, your cardiac surgeon will perform coronary artery bypass surgery at the time of your valve surgery.

Conventional Heart Valve Surgery

Heart valve disease initially may be treated medically but, in most cases, surgery is necessary to repair or replace the damaged valve or valves. Your surgeon will determine which procedure is best for you, taking into consideration your age, medical history, the nature of your heart disease, your lifestyle and your ability to take anticoagulants (medications that prevent your blood from clotting).

For heart valve replacement, there are three main classifications of artificial valves:

• Bioprosthetic valves are from animals specially treated with chemicals to avoid rejection.
• Mechanical valves are made of metal, carbon and/or synthetics. Anticoagulation is required to prevent blood clots.
• Biologic valves are human heart valves obtained from donors after death and frozen for later use (homograft). In the Ross procedure, the patient's own pulmonary valve replaces the diseased aortic valve and in turn is replaced by a homograft valve.

Some valves can be surgically repaired to help them open or close more efficiently. Two common surgical repair procedures are:

• Ring Annuloplasty is a procedure in which the annulus or ringlike part of the valve is tightened by placing a ring of metal, cloth or tissue around the valve.
• Valve Repair is a procedure to reconstruct the leaflets, chordae, and/or papillary muscles of the valve.

The average time required for heart valve surgery is four hours. Your heart valve surgery will be performed by a specialized team:

• Your cardiac surgeon will perform the surgery.
• Surgical assistants will assist with the surgical procedure.
• Nurses will provide surgical instruments and supplies to the team.
• Anesthesiologists will provide you freedom from pain and a deep sleep that prevents any memory of surgery.
• A perfusionist will operate the heart-lung machine that keeps your blood circulating with oxygen.

Heart valve surgery can be performed by three surgical approaches:

• Sternotomy: an incision is made down the middle of your chest separating your breastbone and muscle. The breastbone is closed with stainless steel wires at the conclusion of surgery.
• Thoracotomy: an incision is made in your rib cage similar to lung surgery.
• Minimally invasive surgery: 3-inch incisions are made in or to the right of the sternum. This surgery is now the most common approach for isolated heart value surgery.

Minimally Invasive Heart Valve Surgery

For patients without coronary disease, heart valve replacement/repair can now be performed through very small incisions (3 inches) compared with those used in conventional surgery.

Minimally invasive heart valve replacement surgery is performed in two different ways:

• Aortic valve replacement incisions are performed through an upper mini-sternotomy, in which an incision is made from the sternal notch to the third intercostal space.
• Mitral valve replacement / mitral valve repair incisions are performed through a lower mini-sternotomy, in which a 6-8 cm incision is made at the lower end of the sternum upward to the second intercostal space and extending into the interspace on the right.

Minimally invasive heart valve surgery, while maintaining the quality of the operative procedure may result in:

• Less trauma
• Less blood loss
• Improved cosmesis, particularly with mitral valve surgery
• Less incision pain
• Shorter hospital stay

Cardiovascular Care at Brigham and Women’s Hospital

The Carl J. and Ruth Shapiro Cardiovascular Center at BWH is one of the most advanced centers of its kind in the New England region. Bringing together the full range of cardiovascular services in one building, the Center provides the technology and infrastructure to enable seamless and coordinated care for all cardiovascular patients.

Patient- and Family-focused Care

Brigham and Women’s Hospital (BWH) has long been committed to not only the care of our patients, but also the many other needs that they and their families have. This philosophy of patient- and family-focused care – involving systems and services that emphasize healing in a comfortable, relaxed environment – is a guiding force behind the care we provide at the Center.

Quality of Patient Care

BWH is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and follow established protocols that have been shown to improve patient outcomes. Our Inpatient Satisfaction Survey, sent to patients’ to assess their total care experience, helps us to monitor what we are doing well and where we could improve. We pride ourselves in the Quality of Patient Care we provide and how we compare with other hospitals.

Contact Us

If you believe you should have an evaluation and would like to schedule an appointment with one of our cardiac surgery experts, call 1-800-294-9999 to speak to one of our knowledgeable coordinators who can help to connect you to the doctor that best meets your needs, or fill out an online appointment request form.