The heart is a complex machine, with four valves that regulate blood flow in and out. But sometimes, those valves develop problems.
Valves contain flaps that open and shut like doors to control blood flow. Sometimes, the valves can become narrow, reducing flow — a problem known as stenosis. Or they might not shut as tightly as they should, allowing blood to leak backwards against the normal direction of flow. This is known as regurgitation. Valves that don’t work correctly can stress the heart, causing symptoms and heart damage over time.
How do you pick the best option for you? Choosing between heart valve repair and replacement depends on many different factors. Here’s a guide to help you understand your options to find the right path forward.
The Differences Between Heart Valve Repair And Heart Valve Replacement Surgery
In some cases, specialists can fix a damaged heart valve. “There are many different kinds of repairs,” Dr. Frisoli says. Sometimes, the doctor will place a ring around a stretched-out valve. The ring shrinks the valve down so the flaps, or leaflets, can close better. In other cases, the specialist places clips on the damaged leaflets to keep them from leaking.
When repair isn’t a good option, the doctor can remove the damaged valve and replace it with a new one. There are two types of replacement options:
- Tissue valves: Also known as bioprosthetic valves, these are created from human or animal tissue. They typically need to be replaced after 10 or 20 years, though. That means they aren’t always the best choice for younger patients.
- Mechanical valves: These artificial valves are made of strong, durable materials. Most last for the rest of the patient’s life. But people who receive mechanical valves must take blood thinning medication long term to avoid the risk of blood clots.
For both heart valve repair and replacement, there are two ways to approach the procedure:
- Traditional heart valve surgery: Doctors can repair or replace valves through traditional open-heart surgery. Open-heart surgery is the only option for people who need a mechanical valve.
- Transcatheter treatment: Also known as endovascular treatments, transcatheter treatments are a minimally invasive procedure. A specialist inserts a thin, hollow tube through a vein or artery to reach the damaged valve to repair or replace it.
“Older, sicker patients generally have endovascular treatments because they are less invasive and less risky than open-heart surgery,” Dr. Frisoli explains. “Younger, healthier patients are usually better candidates for traditional surgery. But when both options are available, the doctor does take the patient’s preference into consideration.”
Recovery From Heart Valve Replacement And Repair
For both repair and replacement procedures, the recovery period is much longer for open-heart surgery than transcatheter treatments. “After open-heart surgery, recovery can take a week or so in the hospital, and about two months of regaining strength outside the hospital,” Dr. Frisoli says. “The majority of people receiving endovascular repairs or replacements go home in one or two days.”
After recovery, most people who have a heart valve repair or tissue valve replacement will no longer need to take medications. However, people who receive a mechanical valve replacement have to take blood thinners for the rest of their lives.
Should You Repair Or Replace?
The decision whether to replace or repair depends, in part, on which of the four heart valves is damaged.
Take aortic valve disease, for example. “For aortic stenosis, we almost always replace the aortic valve, because it’s typically too damaged to repair,” Dr. Frisoli explains. For that condition, a minimally invasive valve replacement technique known as TAVR has become common. Other valves, by contrast, are more often repaired than replaced.
Some valves are too damaged to fix. But when repair is a possibility, it’s usually a good one. “We prefer that option because we leave the patient with their own native tissue,” he says.
So should you repair or replace? The answer isn’t always clear-cut.
“It’s very patient-specific,” Dr. Frisoli says. Your doctor will explain your options and the pros and cons associated with each of them.
For some valve conditions, endovascular replacement and repair is available at many hospitals. For others, certain endovascular treatments are available only at a handful of centers through research trials.
Ultimately, patients and their providers should discuss all the possibilities to determine the best way forward, Dr. Frisoli says. Whichever option you choose, he recommends seeking out doctors who perform a lot of them. “There’s data to suggest that the more procedures a provider or institution does, the better the outcomes for patients.”
Dr. Tiberio Frisoli is an interventional cardiologist who sees patients at Henry Ford Hospital in Detroit, Henry Ford Allegiance in Jackson and Henry Ford Health Center – Brownstown.