Patient's Guide to Valvular Heart Disease
While valvular heart disease can seem overwhelming at first, chances for recovery can be strong. As national leaders in treating valve disorders, the cardiologists and surgeons at the Smidt Heart Institute are trained in innovative and collaborative approaches that tailor each treatment plan to a patient's unique needs.
As a leading center with the highest volume of structural heart disease interventions in the U.S., Cedars-Sinai offers an unmatched expertise in treating various stages of heart valve disorders. The guide below will help you understand what heart valves do, common problems, causes and treatment options available if you or a loved one have been diagnosed with a heart valve disorder.
What Do Heart Valves Do?
As your blood circulates through your body, it flows through the heart's four chambers and four valves.
The four heart chambers are:
- Right atrium—gets blood from the body.
- Right ventricle—gets blood from the right atrium and sends blood to the lungs.
- Left atrium—gets blood from the lungs.
- Left ventricle—gets blood from the left atrium and sends blood to the body.
The four valves are:
- Tricuspid valve—gate between the right atrium and right ventricle.
- Pulmonary valve—opening from the heart to the lungs.
- MitraI valve (also called the bicuspid valve)—gate between the left atrium and left ventricle.
- Aortic valve—opening from the heart to the rest of the body.
Common Heart Valve Problems
There are two common problems with heart valves: some do not close the right way, and some do not open the right way. Regurgitation and stenosis are two diseases that doctors most often see and treat.
A heart valve stenosis means that the heart valve does not open all the way, resulting in the heart having to work harder to pump blood through the valve. This can lead to a reduced supply of oxygen throughout the body.
A valve regurgitation means that the heart valves are leaking backwards, and causing the heart to have to pump harder in order to circulate the blood through the heart and body.
Causes of Heart Valve Problems
Heart valve disease is one of the most common causes of heart conditions. Heart valve disease can be caused by:
- Age-related factors
- History of a heart attack
- Congenital heart valve defects
- Infections in the lining of the heart walls and valves
- Rheumatic heart disease
- Degenerative calcification
- Risk factors such as hypertension, high cholesterol or diabetes
Treatment Options—The Decision to Repair or Replace
Heart valve repair or replacement to treat your heart condition can help reduce symptoms, regulate the blood flow to the heart and improve the overall health of your heart. The decision to repair versus replace a heart valve is based on factors unique to each patient. These include things such as which of the four valves is impacted, severity of your condition, nature of the tissue, age and overall medical history.
Whether you need to repair or replace your heart valve, rest assured the expert cardiac care team at Cedars-Sinai will carefully evaluate each case and work with you to personalize your care based on your specific needs.
Repairing a Valve
Repairing a heart valve, if appropriate, is usually the preferred option given its benefits over replacement—maintaining greater heart shape and functions, reduced use of lifelong medications, less infections, increased durability and decreased mortality. At Cedars-Sinai a repaired valve is expected to have a life of at least 10 years and optimally a lifetime (comparable to the minimum expectation for a bioprosthesis). Upon evaluation, if the repaired valve is not projected to last at least that long, the valve is replaced rather than repaired.
Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation. However, the multidisciplinary cardiac care team at Cedars-Sinai will carefully evaluate your specific valvular heart condition to deem repair as the best treatment option. Nowadays, minimally invasive treatment options are used to repair heart valves. In addition to the common transcathered procedure to repair the mitral valve, Cedars-Sinai offers the MitraClip Procedure.
This procedure is performed on a leaky mitral valve and is used to treat mitral valve regurgitation. This innovative new procedure does not require open heart surgery and can be placed in the heart by using a catheter inserted through a vein in the groin. The MitraClip device is passed through the catheter and used to clip the mitral valve closed, to ensure that there is a reduction in the leakage of the mitral valve. Occasionally, it may take more than one MitraClip to successfully close the mitral valve. With correct positioning of the MitraClips, the procedure is successfully completed and mitral regurgitation is reduced, allowing the heart to exert less effort to deliver oxygen to the body.
Find an Expert/Need a Second Opinion?
The Valvular Heart Disease Program at Cedars-Sinai provides expert care and innovative treatment options to bring you optimal results. If you have questions about treatment, need a second opinion or require special care, please contact our team.
Replacing a Valve
When the doctor determines that a patient's heart valve cannot be repaired, it must be replaced. The experts at Cedars-Sinai have extensive experience with all types of valve replacement surgery, including aortic valve replacement, mitral valve replacement and pulmonic (lung) valve replacement. Common procedures include a minimally invasive option known as Transcatheter Aortic Valve Replacement (TAVR) or a more involved procedure known as the Ross procedure.
Transcatheter Aortic Valve Replacement (TAVR)
This minimally invasive procedure fixes the aortic valve without removing the damaged existing valve. A TAVR does not require open heart surgery, and the heart does not need to be stopped.
The surgeon puts a catheter into an artery in the upper leg or through a small cut in the chest. The catheter helps insert the new replacement valve within the old valve. This procedure regulates blood flow in patients with aortic stenosis by allowing the new valve to properly open and close as blood flows through the aorta into the body.
The Ross procedure replaces a diseased aortic valve with another of the patient's own heart valves, the pulmonic valve. The pulmonic valve is in turn replaced by a homograft valve (a pulmonic valve donated by another person). The benefits of this procedure are that the patient does not need to use blood thinners, has less chance of infection and receives a valve that works like a normal human valve.
The Ross procedure is often used in children so that the new aortic valve can grow as the child grows.
Although this is a more complicated operation, surgeons at Cedars-Sinai have extensive experience with the Ross procedure.
Because this procedure requires extensive surgery, not all patients are candidates for the Ross procedure. Patients with serious infections or who are experiencing organ failure as a result of infection are not candidates for this procedure.
The Ross procedure is more complex and technically challenging than a single valve surgery. Some patients will require another operation within 10 to 15 years if the homograft degenerates. This procedure is appropriate in selected young patients who do not have Marfan syndrome or a connective tissue disorder.
Type of Valves
Several different kinds of artificial valves are used for replacement surgery, including:
The most common type of valve used in the United States is the St. Jude valve. In more than 20 years of experience using the St. Jude valve, surgeons at Cedars-Sinai have never had a mechanical valve fail.
While a mechanical valve has an unlimited life, its disadvantage is that patients must take blood thinning medicine (often warfarin) for the rest of their lives and have a blood test done every four to six weeks.
Mechanical valves are recommended for patients:
- With long expected life spans
- With a mechanical valve already in place at a different site than the new valve
- In kidney failure, on hemodialysis or with hypercalcemia (high blood calcium)
- Already taking blood thinners because of a risk of a blocked blood vessel
- Older than 65
- Undergoing valve re-replacement for a blocked tissue valve
- Who can take blood thinners
Several tissue valves are currently used at Cedars-Sinai. The Carpentier-Edwards pericardial valve and the St. Jude Toronto Stentless Porcine valve are the most common.
These valves offer less resistance to the blood flowing through it and patient do not need to take blood thinners. The disadvantage is that these valves usually only last about 15 years.
Tissue valves are recommended for patients who:
- Cannot or will not take blood thinners
- Are younger than 65 years old and need aortic valve replacement but do not have risk factors for blocked valves or who are younger than 70 years old and need mitral valve replacement
- Need to have a blocked mechanical valve replaced
- Are in kidney failure, on hemodialysis or have hypercalcemia (high blood calcium)
- Who are in adolescence and still growing
Homograft valves are donated human aortic valves that are used in select cases. These valves may result in less risk of infection, but the operation is more complex than standard valve replacement.
Homografts are the most resistant to infection, making this the preferred technique for treating aortic root infection and endocarditis at Cedars-Sinai.
The major disadvantages of a homograft include issues with the longevity, size and length. Since homografts depend on human donor availability, there is no assurance that there will be enough valves of the right size and length when needed.
Because our bodies try to reject foreign objects—even when they are present to help, such as replacement valves—severe calcification of the aortic wall may occur, stiffening the leaflets, making the valve less effective. The leaflets of the aortic valve also may degenerate.
Homografts may be considered for elderly patient with a life expectancy less than 15 years who are being treated for a heavily calcified (porcelain or egg shell) aorta. In such cases, a homograft would be done in lieu of other types of aortic valve replacement and endarterectomy of the aorta.
Recovering From Heart Valve Surgery
If you have heart valve surgery, you will probably spend at least 1 night in the Intensive Care Unit (ICU), and will likely be admitted to the Medical Center for about 5 to 7 days after your surgery.
Your recovery time depends on:
- How healthy you were before surgery
- How many valves were involved in the surgery
- The surgical technique used
- You will need to rest and limit your activities at first.
- Your doctor may want you to begin an exercise program or join a cardiac rehabilitation program when you are strong enough.
- You may be able to go back to work in 4 to 6 weeks, if you work in an office. If your job is more demanding, you may need more time for recovery. Discuss this with your doctor.
If you have been given a mechanical valve, you may sometimes hear a quiet clicking in your chest. This is just the sound of the new valve opening and closing, and is nothing to be worried about.
Let Your Dentist Know You've Had Valve Surgery
Having valve repair or replacement surgery means that you need to take certain precautions. Always tell your doctor and dentist that you have had valve surgery. If you are having a surgical or dental procedure, you should take an antibiotic beforehand. This can help prevent bacteria from entering the bloodstream during these procedures and infecting your repaired or artificial valve. Without the antibiotics, you are at risk for developing a serious condition called bacterial endocarditis.
There are many different treatment options available for heart valve disorders. Whether using conventional surgical methods or minimally invasive options, such as robotic surgery, rest assured our highly-skilled team of experts provides comprehensive treatment for your heart condition.