Heart Valve Problems: Is Repair or Replacement Best for You?

Several factors will influence what is your best option
Heart Valve Problems: Is Repair or Replacement Best for You?

Your heart is your body’s pump — the engine that keeps it going. So when it’s malfunctioning, getting it fixed is critical. If the problem lies with one of your heart’s valves, a surgeon can either repair it or replace it. But how does your doctor decide which is best for you?

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First of all, it’s important to seek treatment early if you suspect you have a heart problem, says cardiothoracic surgeon Per Wierup, MD, PhD.

“It’s very important that patients go to their doctors early,” he says. “We can treat most valve problems with minimally invasive procedures. The earlier patients come to us, the better their outcomes will be.”

If your doctor decides you have a problem with one of the valves in your heart, a surgeon will review your case. But the question of whether to repair or replace the valve will depend on several factors, Dr. Wierup says.

What can go wrong with your heart’s valves

Your heart has four valves — mitral, aortic, tricuspid and pulmonary. The valves may have problems from birth. Or a patient’s lifestyle choices and behavior may prompt a need for surgical intervention later in life.

If a heart valve develops a problem, that likely means it’s either leaking or narrowing, which is known as stenosis. These issues also may develop as you age.

Repair or replace? What to expect for each valve

Dr. Wierup explains what your surgeon will consider when deciding between repairing or replacing each valve.

1. Mitral valve — Located between the left ventricle and left atrium of your heart, the mitral valve brings oxygen-rich blood back from your lungs. When it’s working right, the valve opens and closes with each contraction of your heart.

If your mitral valve leaks, you’ll benefit more from valve repair, Dr. Wierup says. Replacing it can actually decrease your heart function.

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Not only does a repair let you keep your own valve, but it improves survival rates and carries a lower risk of:

Fixing mitral valve narrowing, however, is a complicated task, Dr. Wierup says. It depends on:

  • The shape and condition of the valve
  • Blood flow
  • Whether blood clots are present
  • Whether you have atrial fibrillation

If complicating factors are present, then replacing the valve is often the best option, he says.

2. Aortic valve — This valve connects the left ventricle to the aorta. It pumps oxygen-rich blood from the heart to the rest of your body.

Typically, the aortic valve has three cusps or paths for carrying blood out of the aorta. But a few people — up to 2 percent of the general population — are born with only two cusps. This difference forces the heart to pump harder, Dr. Wierup says.

It is less common for the aortic valve to leak. But surgeons typically opt to repair a leak if one occurs. Repairing the valve can: 

  • Decrease the risk of thromboembolism
  • Reduce the likelihood of endocarditis, an infection of the heart’s inner lining
  • Lower the need among young patients for anticoagulant drugs, which thin the blood

Your surgeon may consider replacing a leaking aortic valve if you develop an aneurysm that can burst at the base of the aorta, Dr. Wierup says. An aneurysm will inhibit how well your valve functions.

Aortic valve narrowing is usually caused by calcium buildup or scarring that happens naturally as you age.

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If you were born with a bicuspid valve, the narrowing likely is worse. Surgeons will most often opt to replace the valve with a tricuspid one.

3. Tricuspid valve — Sitting next to the mitral valve, the tricuspid valve separates the heart’s upper and lower chambers. It connects the right atrium to the right ventricle and is responsible for returning blood to the lungs for oxygenation.

In most cases, repair often is the best option for the tricuspid valve, Dr. Wierup says. Leaking is the most common problem; narrowing is rare.

4. Pulmonary valve — This valve connects the right ventricle to the pulmonary artery. It’s responsible for moving blood toward the lungs. The pulmonary valve is less likely to need repair than other valves, Dr. Wierup says.

Pulmonary valve replacement is rare, he says. It occurs most often in children born with a heart defect.

When deciding whether to repair your tricuspid or pulmonary valve, your surgeon will consider several factors, including:

  • The severity of the disease
  • Your age and overall health
  • Whether you need surgery for any other heart problem

Repair is typically a better option, he says, because it:

  • Decreases infection risk
  • Preserves and maximizes heart function
  • Reduces long-term need for blood thinners
  • Improves survival, both short-term and long-term

What to expect with a valve replacement

Heart valve replacement involves either open heart surgery or a minimally invasive procedure. It will depend on the particulars of your case. In most cases, you’ll need a new replacement every 10 years to 15 years, Dr. Wierup says.
Talk to your doctor if you have questions about whether valve repair or replacement is best for you.

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