Heart Valve Surgery

The heart has four valves that open and close with every heartbeat to keep blood flowing in one direction. When a valve becomes narrowed, known as stenosis, or leaky, known as insufficiency or regurgitation, it can no longer do its job, which strains the heart and, if left untreated, can lead to heart failure that may become irreversible. Heart valve surgery treats serious structural and functional valve disease in one of two ways. Repair keeps the patient's own valve and corrects the damaged parts, so its natural tissue and function are preserved. Replacement exchanges the valve for an artificial one, either mechanical or made from biological tissue. The aortic, mitral, tricuspid and pulmonary valves can all be treated, and more than one valve, or a valve together with the coronary arteries, can be addressed in the same operation.

Heart valve surgery is recommended when a valve has significant narrowing or leakage that affects how the heart works, often once symptoms such as breathlessness, tiredness, chest discomfort, palpitations, dizziness or swelling appear, or when tests show the heart is starting to strain even before symptoms become severe. Repair is most commonly used for a leaking mitral valve: when the structures that hold the valve are damaged and blood leaks backward, the tissue is repaired to stop the leak, and repair can also help some patients with mitral narrowing. Where the valve is too damaged to repair, or the disease is very advanced, replacement is the safer choice. The decision between repair and replacement, and between an open and a minimally invasive or robotic approach, is made for each patient after a careful assessment of the heart.

Heart valve surgery is carried out under general anaesthesia. A heart-lung machine takes over the work of the heart and lungs so the heart can be safely stopped and opened, the valve is reached and either repaired or replaced, and the heart is then restarted. In a repair, the damaged parts are removed, the remaining tissue is reconstructed, new supporting cords are created or the leaflets are mended, and a supporting ring is usually placed around the valve; the repair is tested during the operation, and if it is not enough, further steps or a replacement may follow. The valve can be reached through a standard incision in the centre of the chest or, in suitable patients, through small side incisions or a robotic approach that leaves the breastbone intact, working through openings of only a few centimetres while a camera gives a magnified view. A valve operation usually takes around 3 to 5 hours.

A good candidate has valve disease serious enough to need surgery, confirmed by tests, and is well enough to undergo an operation with cardiopulmonary support. Whether a minimally invasive or robotic approach is suitable depends on the valve, the anatomy and the overall picture; almost all valve procedures can be done in a minimally invasive way except where there are severe adhesions in the chest or the situation is very urgent, and these approaches are used in adults rather than young children. Assessment includes an echocardiogram to study the valve in detail, along with other heart and general health tests, and blood-thinning medicines and certain other drugs are adjusted in advance under medical guidance. For international patients, much of this can begin remotely, with existing scans and reports reviewed before travel and the final assessment, including echocardiography, completed on arrival so the right operation is planned.

After surgery, patients spend about one day in intensive care for close monitoring, then move to the ward, with a total hospital stay of around 5 to 7 days. A minimally invasive or robotic operation generally means less pain, less bleeding, a lower risk of infection and a faster return to daily life, often within about two weeks, while recovery after open surgery takes longer. Heart valve surgery is a major operation, so planning a trip abroad means allowing more time than for minor procedures: it is sensible to stay in the destination city for about two to three weeks so the heart and the wounds can be checked and stabilised before flying, and the surgeon confirms when air travel is safe. Light walking is encouraged early, while lifting and strenuous effort are limited for several weeks. Afterwards, follow-up continues remotely by message, photo or video, blood-thinner monitoring is arranged with a clinician near home where needed, and international patient teams provide interpreters and coordinators so that language is never a barrier.

Heart valve surgery is a major but well-established operation, and in experienced hands in a proper hospital setting the results are very good, though as with any heart surgery there are risks to weigh against the serious dangers of leaving valve disease untreated. General surgical risks include bleeding, infection, an irregular heartbeat and reaction to anaesthesia, and there are specific considerations such as the need for blood-thinning treatment. The key advantage of repair is that the patient keeps their own valve, which stays closer to normal in function, resists infection better than an artificial valve and, after a mitral repair, usually needs blood thinners only for the first three to six months; studies show repair gives a greater long-term benefit. A mechanical valve is very durable but needs lifelong blood thinning, while a tissue valve usually does not but may wear over many years. Choosing an experienced team, planning enough recovery time before flying and following the medication and follow-up plan are the keys to a safe experience and a lasting result.