Heart Valve Repair & Replacement
Keeping blood flowing correctly
Structural Solutions for Heart Valve Disease
At Lahey Clinic, you have access to experts who diagnose and treat all types of heart valve disease. We tailor treatment to your unique situation. But our goal is always the same: to relieve your symptoms, improve your quality of life and help your heart stay as healthy as possible.
If a traditional, open-heart procedure is best for you, we’ve got you covered. But if you’d benefit most from newer, less invasive techniques, such as transcatheter aortic valve replacement (TAVR), they’re available, too. We also provide options when surgery isn’t possible.
In any case, you get exceptional care from Lahey’s highly skilled, compassionate team.
Conditions We Treat
We treat the full range of structural heart conditions, including:
- Aortic valve disease
- Atrial fibrillation (AFib)
- Atrial septal defect (ASD)
- Cardiogenic shock
- Cardiomyopathy
- Mitral valve disease
- Patent ductus arteriosus (PDA)
- Patent foramen ovale (PFO)
- Pulmonary valve disease
- Tricuspid valve disease
- Ventricular septal defect (VSD)
The Valves of the Heart
Heart valves are flaps that open and close in an orderly fashion to keep blood moving in one direction. There are four valves:
- Your tricuspid valve separates the upper right chamber (atrium) from the lower right chamber (ventricle).
- Your pulmonary valve separates your right ventricle and the artery that carries blood to your lungs to pick up oxygen (pulmonary) artery.
- Your mitral valve separates your left atrium (where oxygen-rich blood returns from your lungs) and your left ventricle.
- Your aortic valve separates your left ventricle and the large artery that carries oxygenated blood from your heart to the rest of your body (aorta).
Types of Heart Valve Disease
Heart valve disease occurs when your valves don’t function as they should. Types include:
- Atresia: Lack of an opening of a valve that occurs before birth
- Regurgitation: Leaking that results when your valve doesn’t close completely
- Stenosis: Narrowing heart valve opening that makes it difficult for blood to flow through
More About Heart Valve Repair & Replacement
Possible causes of heart valve disease that develops later in life include:
- Advancing age
- Certain medications
- Genetics
- Heart attack
- Infections
- Lupus
- Procedures, such as radiation treatment
Symptoms of Heart Valve Problems
Symptoms of heart valve disease can vary depending on the type you have. In some cases, you may not notice symptoms.
If symptoms develop as an adult, you may have:
- Breathing difficulties.
- Chest pain.
- Dizziness or fainting when standing up.
- A fast heartbeat or feeling that your heart skips a beat.
- A heart murmur.
- Swelling around your eyes, ankles or abdomen.
- Unusual tiredness.
Prenatal and newborn screening may help find heart valve disease in young babies.
As an adult, we may recommend screening if you have risk factors.
We commonly use echocardiography to make a diagnosis. This imaging test creates moving pictures of your heart in real time.
Other tests we may use include:
- Chest X-ray
- Electrophysiology study
- Stress test
We consider your condition, medical history and lifestyle when deciding on your treatment.
In some cases, that may include medication. It doesn’t reverse heart valve problems, but it may help manage symptoms or lower your risk of complications.
Only heart valve surgery or a catheter-based procedure can correct heart valve disease. There are a variety of options to repair or replace your valves. We speak with you about the benefits and potential risks of your options.
Aortic Valve Treatments
Calcium may build up in your aortic valve causing it to narrow, or your valve may begin to leak. In some cases, repair of the valve is possible. But aortic valve replacement is one of the most common types of heart surgery we perform.
Aortic Valve Surgery
Traditional aortic valve surgery requires opening your chest and placing you on heart-lung machine. The machine takes over the work of these organs during your operation.
Minimally invasive options are also possible. These procedures use advanced techniques and smaller incisions, either in the center of your chest or the upper right.
Surgery involves removing your damaged valve and replacing it with a metal valve or a biological valve made with tissue from a cow or pig.
Mechanical valves hold up very well. But if you receive one, you must take blood thinners for the rest of your life. Biological valves are less durable, but don’t require blood thinners. Your surgeon will talk with you about which option is best in your case.
Other surgical options are less common. They include:
- Swapping your pulmonary valve for the aortic valve and replacing the pulmonary valve with a valve from a donor (Ross procedure).
- Using a human valve from a deceased donor (homograft replacement).
Transcatheter Aortic Valve Replacement (TAVR)
In this procedure, we crimp an animal tissue valve and mount it on the tip of a catheter, a thin flexible tube. Usually, we insert the catheter into an artery in your groin and move it toward your heart with X-ray guidance.
Once we reach your old, worn-out aortic valve, we release the new valve with a ballon inflation technique. The new valve pushes aside the old valve and remains in that space.
TAVR is approved for the treatment of aortic valve stenosis. Currently there a limited options for transcatheter treatment of purely leaking aortic valves.
Our team of surgeons and interventional cardiologists will evaluate you to determine if TAVR is an option for your condition.
Mitral Valve Treatments
The most common disorder of the mitral valve is regurgitation caused by problems with the way the valve closes.
All mitral valve operations are open-heart procedures. They involve accessing your mitral valve through your heart’s upper chambers.
Traditionally, surgery involves making an incision about 6 to 8 inches long in the middle of your chest. With newer techniques, we can use a smaller incision about 4 to 6 inches long. We may also perform a right thoracotomy. This involves operating through a 4-inch incision on the right side of your chest around your nipple. We make a second incision in your groin that allows us to connect you to a heart lung machine.
Mitral Valve Repair
Repair is the gold standard treatment for mitral valves that begin to break down. It allows you to keep your own valve. This is best for your heart and your long-term well-being. You’re not required to take any special medications after surgery.
Repair techniques are complex and require expert surgeons. Our team has the expertise and experience you need for excellent results.
Mitral Valve Replacement
When mitral valve repair isn’t possible, replacement is your best option. We can give you an artificial heart valve made of metal or animal tissue from a cow or pig. You must take lifelong blood thinners if you get a metal valve. Animal tissue valves don’t require blood thinners, but they’re not as durable as metal valves. Your surgeon will talk with you about the pros and cons of each type. You decide what’s best for you.
Catheter-Based Mitral Valve Interventions
We may recommend MitraClip if you’re not a good candidate for surgery. This small device stops leaking by clipping together the leaflets that form your valve.
We may also recommend a catheter-based treatment called mitral valvuloplasty if you have mitral stenosis caused by scarring from rhematic fever. The treatment involves inflating a balloon on the tip of a catheter to open a narrowed valve and help blood flow better.
Tricuspid Valve Treatments
Regurgitation is the condition that most commonly affects the tricuspid valve.
Tricuspid Valve Repair
Often, we can repair your tricuspid valve with an annuloplasty ring. The ring is semi-rigid. It encircles and cinches down on your valve. This may prevent leakage.
Tricuspid Valve Replacement
In some cases, we must replace your tricuspid valve rather than repair it. Usually, we use an animal tissue valve. You may need a pacemaker after this surgery.
