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Heart Valve Repair

Heart valve repair is used to treat a number of conditions that cause one or more valves in your heart to stop working properly. These conditions include valve stenosis, a condition in which the valve flaps become stiff, thick or fused; and valve prolapse, a condition in which a valve does not close tightly, resulting in leakage or regurgitation. Both these conditions can lead to reduced or restricted blood flow, a weakened heart, heart failure or other serious cardiac conditions.

Baptist Health is nationally recognized for excellence in heart valve repair. We offer a full spectrum of heart care and the latest approaches in heart valve repair procedures. Best of all, you’ll appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure.

What Is Heart Valve Repair?

Heart valve repair covers a number of procedures to treat a variety of conditions related to heart valves. Depending on your condition, a catheter may be used to widen the valve opening with a balloon or reshape the valve by placing a clip on it. In many cases, however, your cardiologist will recommend surgery that may include removing calcium deposits and scar tissue at the valve opening, cutting fused valve leaflets apart, removing excess tissue, repairing any holes or tears, and reinforcing or tightening the ring around the valve to restore proper function.

If the valve cannot be successfully repaired, your surgeon may instead replace the valve with a mechanical or biological replacement. The procedures that may be used for heart valve repair include:

Balloon Valvuloplasty

In this procedure used to treat stiffened or narrowed pulmonary, mitral or aortic valves, the surgeon guides a catheter tipped with a balloon through a blood vessel in your arm or groin to the narrowed valve. Once in position, the balloon is inflated to widen the valve, improving blood flow.

Transcatheter Valve Clip Procedure

This procedure is most commonly used on patients with mitral valve regurgitation who are too old or weak to undergo other surgical options. A catheter tipped with a small clip is threaded through your arm or groin to the valve that needs to be repaired. The clip is then placed on the valve, reshaping it so it closes properly.

Commissurotomy

For cases of aortic valve stenosis where a balloon valvuloplasty is not an option, your surgeon may perform open-chest surgery to remove calcium deposits and scar tissue to clear the valve’s opening.

Annuloplasty

During this procedure, the fibrous tissue at the base of a heart valve can be resized by removal of excess tissue or by sewing a specially designed ring around the base of the heart valve.

Mitral Valve Repair

A hardened or loose mitral valve can be surgically repaired by trimming or reshaping one or both of the flaps that open and close the valve.

What Can Heart Valve Repair Accomplish?

Heart valve repair can restore proper blood flow and circulation to your body, giving you more energy. It can also:

Reduce or eliminate heart murmurs or palpitations
Reduce or eliminate swelling in feet and legs
Reduce or eliminate chest discomfort or pain
Enable you to be more physically active without experiencing fatigue or shortness of breath

What Can I Expect During the Procedure?

What you should expect during the procedure will vary greatly depending on the type of valve repair performed. Some repairs can be done as minimally invasive procedures, while others are done as traditional open-chest procedures.

Open-Chest Surgery

To begin open-chest surgery, a large incision is made in the chest so the surgeon can reach the heart. You will be connected to a heart-lung bypass machine that will do the work of your heart and lungs while the surgery happens. The diseased valve is repaired. The blood circulating through the bypass machine will be allowed to circulate back into your heart, which will be shocked back into rhythm. The surgeon will watch to see that the new valve and your heart are working well. The incision will be closed. Tubes will be inserted to drain fluid away from the heart during healing.

Minimally Invasive Surgery

A minimally invasive valve repair procedure may be recommended, especially if a person is not a good candidate for traditional open chest surgery. Minimally invasive surgery to repair a heart valve requires only a few small incisions. Those incisions can be made in the chest between the ribs, vertically in the sternum or, in the case of an aortic valve repair, in the groin. A tiny camera and long, thin surgical instruments are inserted through the incisions in order to repair the valve. Depending on the type of procedure, you may be connected to a heart-lung bypass machine similarly to an open chest procedure.

Balloon Valvuloplasty & Transcatheter Valve Clip Procedure

Catheter procedures used for heart valve repair are relatively quick and simple. First, you will be given an IV with a sedative to help you relax, and local anesthesia at the catheter insertion site. Unlike other types of valve repair, you will be awake throughout the procedure. The catheter will be threaded through a blood vessel in your arm or groin to your heart. Contrast dye is then injected through the catheter. This helps locate the valve using X-rays or other imaging devices to make sure the catheter is properly positioned. During a balloon valvuloplasty, the balloon may be inflated several times, during which you may feel some discomfort or dizziness. Once the balloon has helped open the valve or the clip has been placed, the catheter is removed, and the surgeon will close the site where the catheter was inserted.

Commissurotomy

During this open-chest procedure, the surgeon removes calcium deposits and scar tissue to allow the heart valve to open properly.

Annuloplasty

During this open-chest procedure, the surgeon will remove any fibrous tissue at the base of a heart valve so the valve can close tightly. A specially designed ring may be sewn around the base of the heart valve to strengthen it or narrow an enlarged valve.

Mitral Valve Repair

A faulty valve can be repaired through minimally invasive procedures or open-chest surgery. The surgeon cuts away excess tissue in the cusps of the valve and then sews the edges together or shortens or connects the cords that act as hinges on the valve.

Recovery

Your recovery will depend heavily on your condition before the procedure, and the type of procedure performed. Recovery may take anywhere from a few weeks to many months, and you will likely be enrolled in a cardiac rehabilitation program.

Balloon Valvuloplasty & Transcatheter Valve Clip Procedure

The typical hospital stay after a catheter procedure for heart valve repair is 24 hours. If the catheter was inserted through your groin, you will remain in bed for the first few hours. A nurse will monitor your vital signs, circulation and any pain or discomfort. You will receive pain medication as necessary, and encouraged to drink lots of fluids to flush the contrast dye from your system. Discomfort around the insertion site may continue for a few days or weeks, and can be treated with over-the-counter medications. You will want to avoid strenuous activity at first, but should be fully recovered from the procedure within a few weeks.

Open-Chest Surgery

Immediately after the surgery, you will gradually wake up from the anesthesia. You will be left on a ventilator and closely monitored until you take over breathing on your own. Once you can breathe fully on your own and cough, you will be taken off the ventilator and your stomach tube will be removed. Your nurse will help you take deep breaths and cough every couple hours, which will likely be uncomfortable, but prevents mucus from collecting in your lungs. You will typically spend several days in the ICU, where an ECG machine will constantly monitor your vitals such as blood pressure, heart rate and oxygen level. You will be given pain medications as needed, and may remain on an IV for medications to control blood pressure or problems with bleeding.

As your condition stabilizes and you become more active and start eating solid foods, you will be moved from the ICU to a regular hospital room to recover. Your hospital stay will likely last about a week before you are ready to be sent home. Once at home, you will need to keep your surgical area clean and dry, and follow any specific bathing and medication instructions. It will take several weeks or more before you are ready to return to work, and several months or more before you are fully recovered.

Minimally Invasive Procedures

The recovery process for minimally invasive procedures is similar to the recovery process for open-chest surgery, especially if placed on a bypass machine. You may experience less pain and recover more quickly; however, since the surgical sites are smaller and require cutting through less bone, or none at all.

Estimated Recovery Timeline

Many people feel relief of symptoms almost immediately. You will tire easily in the days following hospital discharge, but your energy will increase as you heal. Recovery is often faster for those who have had minimally invasive surgery. Make sure to keep your follow-up appointments and follow instructions for heart-healthy eating and exercise.