Valve Replacement

The heart pumps oxygen and nutrient-rich blood out to the tissues and removes waste from the bloodstream throughout the body. Arteries carry oxygenated blood away from the heart. Veins carry blood back to the heart where it can be sent through the lungs to be oxygenated again.^1,2

Heart structure

The heart’s structure has 4 chambers. The upper chambers are called atria, and the lower chambers are called ventricles. When the heart beats, it contracts and relaxes, squeezing the blood out of the chamber and then relaxing to refill with blood.^1,2

As the heart pumps blood, it goes through a sequence of contractions. For the heart to work properly, it relies on each of the chambers to beat in an organized way. The heart also has 4 valves that play a critical role in circulation.^1,2

Heart valves

The valves open and close to allow blood flow in a single direction and prevent backflow. A properly formed healthy valve should be flexible, be able to open completely, and tightly close to prevent leakage. The valves include:^2-4

• Tricuspid valve – opens to allow blood to flow from the right atrium to the right ventricle
• Pulmonary valve – closes the right ventricle and opens to let blood out to the lungs
• Mitral valve – opens to allow blood to flow from the left atrium to the left ventricle
• Aortic valve – opens to allow blood from the left ventricle to leave the heart through the aorta and out into the body

Heart valves can develop problems due to diseases, aging, or an abnormality that was present at birth (congenital). If there is damage to a heart valve, it may need to be repaired or replaced. The cause of the damage will influence the procedure selected. It is also influenced by which valve needs treatment and the severity of symptoms.^3-5

Valve problems

The 2 main valve issues are regurgitation and stenosis. Regurgitation happens when blood flows back into the valve as its leaflets close or leaks out through the leaflets after they are closed. This causes added strain on the heart to pump the same amount of blood.^3,4

Stenosis is the narrowing of a heart valve, preventing it from being able to open and close properly. The flaps of a heart valve can become stiff or fuse together, preventing it from fully opening. This causes the heart to work harder to pump blood through the valve, resulting in reduced oxygen supply.^3,4

Valve repair

Valve repair preserves the valve, leaflets, and the subvalvular apparatus. Often used for mitral or tricuspid valve regurgitation, it can also be used to relieve tightness (stenosis). A balloon procedure similar to an angioplasty can be performed to try to open up a tight valve. This is called a balloon valvuloplasty.⁵

This is done via left heart catheterization. During this procedure, the catheter has an expandable balloon attached which is threaded into the heart and the tightened valve. The balloon is then inflated to reopen the valve and separate the leaflets. Although not a permanent fix, it can improve blood flow and alleviate symptoms.⁵

Valve replacement

Serious valve problems can be treated surgically, and valve replacement can restore functionality and allow many people to return to full, active lives.¹

The two valves most commonly replaced are the aortic valve and the mitral valve. If your heart failure is caused by valvular disease, replacing the valve may fix your heart failure. Replacement valves can be mechanical or biological.^1,3

A mechanical valve is made of durable, medical-grade materials. A biological valve is made from the tissue of a cow, pig, or human. The choice of which valve to use is based on many factors, like your age, other health conditions, and choice. Younger people may opt for a mechanical valve as they last longer, but they require that the patient take a blood thinner to prevent the valve from getting clots on it. Older patients may opt for a biological valve to avoid having to take blood thinner medications. Older patients are more likely to have other medical conditions, so taking a blood thinner may not be the best option.⁵

Another biological approach is the Ross procedure. The Ross procedure replaces a defective aortic valve with a person’s own pulmonary valve. The pulmonary valve is generally less damaged because it is under less stress, so it does not have to work as hard as the aortic valve. The pulmonary valve is then replaced with a donor valve.^4,7

A less invasive procedure is a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). This is when a replacement valve is inserted into the aortic valve position and pushes the leaflets of the old valve out of the way.^3,5,6

The TAVI/TAVR is a minimally invasive procedure that uses the left heart catheterization approach through the femoral artery in the groin to insert a new valve within the damaged valve, without removing the damaged valve. A second approach goes through an incision in the chest through a large artery in the chest or the tip of the left ventricle (apex). This is typically done in older patients who are not able to undergo open-heart surgery due to age or other medical conditions.^3,5,6

Your healthcare team will discuss which option may be right for you if valve repair or replacement is advised.