Heart Valve Replacement Without Open Heart Surgery

Heart valves can be replaced with open heart surgery or with less invasive procedures that don’t require your chest to be opened. Known as transcatheter valve replacement, this type of procedure has fewer risks and a faster recovery time.

Your heart has four valves that open and close in a controlled way to ensure that blood flows in the right direction through the chambers of your heart. Sometimes a valve can no longer open fully or close tightly, which can lead to heart complications in more severe cases.

If the damaged valve can’t be repaired, it may need to be replaced. Heart valves can be replaced with open heart surgery or with less invasive procedures that don’t require your chest to be opened.

A minimally invasive option that may be used for valve repair is a catheter procedure. This involves having a thin, flexible tube (catheter) inserted into an artery in your groin, which is then threaded to the affected heart valve. The catheter is equipped with specialized tools that allow a surgeon to replace the damaged heart valve.

But not everyone is a candidate for this type of procedure. Also, as with any medical procedure, it does have risks. However, for the right candidate, a minimally invasive valve replacement may be the best solution to a potentially life threatening condition.

All four heart valves can be replaced without open heart surgery. According to the American Heart Association , the most commonly replaced valves are the aortic and mitral valves, while the pulmonary and tricuspid valves are rarely replaced.

Aortic valve

The aortic valve allows blood to be pumped from the left ventricle up into the aorta and out to the rest of the body.

A transcatheter aortic valve replacement (TAVR) procedure is often done in cases of aortic valve stenosis — a stiffening of the valve that prevents it from opening properly to allow sufficient blood flow.

Mitral valve

The mitral valve allows blood to travel from the heart’s left atrium (upper chamber) down to the left ventricle (lower chamber), the heart’s main pumping chamber.

Mitral valve regurgitation is the most common valve problem. This means that the valve doesn’t closely tightly, which allows blood to leak backward into the left atrium. It’s often treated by repairing the valve, rather than by replacing it.

A transcatheter mitral valve replacement (TMVR) is an especially challenging catheter-based procedure because of the valve’s location, size, and configuration.

A 2021 study suggests that because of the limitations and challenges related to mitral valve repair, advances in TMVR could be a game-changer for individuals who have severe forms of this common condition.

Pulmonary valve

The pulmonary valve allows the right ventricle to pump blood into the pulmonary artery, which carries blood to the lungs where it becomes oxygenated before returning to the heart.

Pulmonary valve replacement is still primarily done with open surgery, but recent advances in transcatheter pulmonary valve replacement (TPVR) are starting to provide doctors with more options.

Tricuspid valve

The tricuspid valve allows blood to flow from the right atrium down to the right ventricle.

A 2022 study notes that surgical tricuspid valve replacement is rare. However, transcatheter tricuspid valve replacement is offering hope for people who can’t have open heart surgery.

Transcatheter procedures are generally recommended for individuals who aren’t good candidates for valve surgery or who have other heart problems, frailty, or coexisting medical conditions that would make undergoing surgery a serious health risk.

Open heart surgery for aortic valve repair used to be the preferred approach for younger people and those deemed low risk, while TAVR was recommended for older individuals.

However, a 2020 report suggests that TAVR may be appropriate for low risk individuals, too.

The particulars of a transcatheter valve replacement procedure vary somewhat depending on which valve is being replaced. Other factors, such as your overall cardiovascular health, may also cause some variations in how the procedure is done. In most cases, though, the procedures are similar.

Transcatheter valve replacement is typically done in a hospital by a cardiologist — a doctor who specializes in treating heart conditions. The procedure typically involves the following steps:

• You may be given anesthetics to put you into sleep-like state (general anesthesia), or you’ll be given medication to make you drowsy and relaxed. You’ll also be given medications intravenously to help prevent blood clots from forming during and immediately after the procedure.
• An incision will be made in your groin, though sometimes the first incision is made in the chest or around the collarbone.
• A thin, flexible catheter is then inserted into an artery and carefully guided to the heart valve that needs to be replaced. The cardiologist will use echocardiogram imaging to ensure the catheter is placed in the correct position.
• The replacement valve will be folded inside the catheter. This new valve will consist of tissue from a pig, cow, or human donor.
• A balloon on the tip of the catheter will inflate, which allows the cardiologist to secure the new valve in place. In some procedures, the old valve may be removed before the new valve is put in place.
• Once the replacement valve is secured, the doctor will check for valve leaks and will make sure the new valve and your heart are functioning well. If there are no immediate problems, the catheter will be removed, and the incision will be closed.

A shorter recovery is one of the main advantages of transcatheter valve replacements over surgical procedures. After the procedure, you can expect to stay in the hospital for a few days while your heart function is monitored.

You’ll be given information on your recovery timeline and any activity restrictions before you’re discharged from the hospital. It’s important to know what side effects to look out for and how you should respond.

You may be able to resume most of your usual activities within a couple of weeks. But heavy lifting and vigorous activity will be off limits for a few more weeks. By comparison, open heart surgery usually requires at least 6 to 8 weeks of limited activity.

You’ll likely have a follow-up appointment with your cardiologist a week or two after leaving the hospital. You’ll also need regular follow-up appointments for several months after your procedure.

A doctor may also prescribe cardiac rehabilitation, which can help teach you how to exercise safely and follow a heart-healthy lifestyle.

The main risks of transcatheter valve replacements are bleeding and damage to the blood vessel used for the procedure. In some cases, a valve may slip out of place or start leaking, which may require a follow-up procedure.

There’s also a small risk of blood clot formation, though you should receive medications to prevent blood clots while you’re in the hospital. You may also be prescribed a blood thinner to help prevent future blood clots.

Another potential risk is the development of an arrhythmia or heart rhythm disturbance after the procedure.

When to get medical care

If you experience chest discomfort or heart palpitations during your recovery, contact a doctor immediately.

Call 911 or local emergency services if you experience severe chest pain or shortness of breath.