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Heart Valve Surgery – Options

Heart Valve Repair Options

Traditional Heart Surgery

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves. While this approach remains in use, today most patients with isolated valve disease can be treated with minimally invasive techniques.

Minimally Invasive Heart Valve Surgery

Minimally invasive surgery is a type of surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay. Heart valve surgery is the most common minimally invasive procedure. Your surgeon will review your diagnostic tests prior to your surgery to see if your are a candidate for minimally invasive valve surgery. Learn more about minimally invasive heart surgery.

Traditional heart surgery incision: median sternotomy

Minimally invasive approach:  partial upper sternotomy

Minimally invasive approach: small right thoracotomy incision

Often, the heart surgeon and cardiologist will use transesophageal echocardiography during the operation to help determine the functioning of the valve before and after surgery.

  • Commissurotomy Fused valve leaflets are separated to widen the valve opening. See illustrations to the right.
  • Decalcification Calcium deposits are cleaned off the valve leaflets, allowing them to be more flexible and close properly.
  • Triangular resection If a portion of the mitral valve leaflet is flail (floppy), and bows back into the left atrium, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. Learn more.
  • Triangular Resection Mitral Valve Repair If a portion of the mitral valve leaflet is flail (floppy), and bows back into the left atrium, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. Learn more.

Heart valve prior to commissurotomy

Heart valve prior to commissurotomy

Ruptured chords at free edge of posterior leaflet. Region to be resected is indicated.

Abnormal segment has been removed. Leaflet edges are sewn together

Annuloplasty completes the repair.

  • Annulus supportIf the valve annulus is too wide, it may be reshaped or tightened by sewing a ring around the annulus (annuloplasty). The ring may be made of tissue or synthetic material.
  • Patched leafletsThe surgeon may patch leaflets with tears or holes with tissue patches.
    • Patched Leaflet, Pre-Operation

    Patched Leaflet, Post-Operation

    Patched Leaflet, Post-Operation

    Patched Leaflet, Pre-Operation

    • When you have aortic or pulmonic valve disease, heart surgery most often requires replacement of the valve. In some cases, the aortic valve can be repaired.

    • Bicuspid aortic valve repairIf you have a bicuspid aortic valve (two leaflets instead of three), the surgeon may be able to repair the valve by reshaping the aortic valve leaflets, allowing the valve to open and close more easily.