Heart Valve Repair & Replacement

If your doctor determines that medical management is not an option they may refer you to a cardiothoracic surgeon to discuss surgical or interventional options, which include heart valve repair, heart valve replacement, transcatheter aortic valve replacement (TAVR), or transcatheter mitral valve replacement (MAVR).

Heart Valve Repair

Valve repair can usually be done on congenital valve defects (defects you are born with) and has a high success rate for treating mitral valve defects.

The cardiothoracic surgeons at San Antonio Regional Hospital may recommend one of the following heart valve repair options:

• Commissurotomy is used to repair narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
• Valvuloplasty strengthens the leaflets and provides more support which lets the valve close tightly. This support comes from a ring-like device that the surgeon attaches around the outside of the valve opening.
• Reshaping requires the surgeon to cut out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
• Decalcification is the removal of calcium buildup from the leaflets. Once the calcium is removed the leaflets can close properly.
• Repair of structural support replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.
• Patching is where the surgeon covers holes or tears in the leaflets with a tissue patch.

Heart Valve Replacement

Heart valve replacement surgery is used to treat any heart valve disease that is sever or life threatening. Sometimes, more than one valve is damaged, so patients may need more than one repair or replacement.

There are two kinds of valves used for valve replacement:

• Mechanical valves, which are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong and long lasting. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines (called anticoagulants) for the rest of their lives.
• Tissue valves, which are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft). Patients with tissue valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, however, and they may need to be replaced every 10 years or so. Tissue valves break down even faster in children and young adults, so these valves are used most often in elderly patients.

Your doctor will discuss with you which type of valve is best for you.