Valve Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Cardiac valve surgery addresses diseased heart valves — most commonly aortic and mitral valves — through repair (valvuloplasty) or replacement with mechanical or bioprosthetic prostheses. Surgery is performed on cardiopulmonary bypass (CPB) via median sternotomy or minimally invasive approaches.

Repair or replacement is indicated for severe symptomatic aortic stenosis, aortic regurgitation, mitral regurgitation, or mitral stenosis confirmed by echocardiography, with evidence of haemodynamic compromise, reduced exercise capacity, or declining ventricular function.

Via median sternotomy, cardiopulmonary bypass is established and the heart arrested. Valve repair uses annuloplasty ring placement, leaflet resection/reconstruction, and chordal techniques. Replacement uses a mechanical (requiring lifelong anticoagulation) or bioprosthetic (tissue) valve prosthesis.

ICU stay is typically 1–2 days, followed by 5–7 days on the ward. Cardiac rehabilitation begins at 4–6 weeks. Sternal movement precautions apply for 6–8 weeks. Mechanical valve recipients require lifelong warfarin anticoagulation; bioprosthetic recipients typically do not.

Risks include stroke (1–2%), bleeding, deep sternal wound infection (1%), atrial fibrillation (20–40% transient), prosthetic valve endocarditis (0.5–1%/year), structural valve deterioration in bioprosthetics (10–15 years), and thromboembolism in mechanical valves without adequate anticoagulation.

Isolated mitral valve repair carries operative mortality below 1% at experienced centres, with superior long-term outcomes compared with replacement. Mechanical valves last over 25 years; bioprosthetics last 10–15 years. TAVI (transcatheter aortic valve implantation) is now standard for high and intermediate surgical risk patients.