Heart valve replacement: what happens, risks and recovery

Heart valves keep blood flowing one way. They can become too narrow, as in aortic or mitral stenosis, or leaky, as in regurgitation, and a bicuspid aortic valve is one that is born with two flaps instead of three. NHS.UK says replacement helps symptoms such as chest pain, dizziness, breathlessness, palpitations and tiredness, and may be recommended for severe disease even without symptoms to prevent heart failure.

It is not always the answer. NHS.UK says mild valve disease without symptoms may need no treatment, and symptoms of mild or moderate disease can usually be treated with medicines. Surgery will only be recommended if the benefits outweigh the risks for you, and the page adds that for people with severe disease the risks of surgery are lower than those of leaving it untreated.

NHS.UK lists surgery to repair a valve that is not seriously damaged, a clip passed through a catheter to repair a leaky valve, and balloon valvuloplasty to widen a narrowed valve. None suits everyone. Transcatheter aortic valve implantation, TAVI, is described as an option for aortic stenosis when other surgery is unsuitable or too high risk, for example because of age or because you are too unwell for open heart surgery.

NHS.UK describes two main types. Mechanical valves are made of carbon and metal, are usually recommended for younger people because they last a long time, and need anticoagulants such as warfarin for the rest of your life because of clot risk. Tissue valves come from pigs or cows and usually last 15 to 20 years, so a repeat operation may be needed. They are usually recommended for older people and for those who cannot or do not want to take anticoagulants.

Ask what your own plan would be for the next operation and how much warfarin monitoring will affect your work and travel. A Leeds congenital heart leaflet also notes that pregnancy with a mechanical valve carries risk to both mother and baby, so raise any pregnancy plans early.

The British Heart Foundation says you will have appointments before surgery covering your history, medicines and allergies, with tests that may include an ECG, chest X-ray, echocardiogram, CT or cardiac MRI, blood tests, MRSA checks and lung tests. You will also need a dental check-up before surgery to reduce the risk of an infection of the heart called endocarditis. Check with your team how long before the date this should be done.

Consent is usually completed on the day of surgery. If nerves are affecting daily life, the BHF suggests speaking to your GP or healthcare team. Smoking is something NHS.UK says not to do after surgery, and stopping beforehand is sensible. Fasting rules and medicine changes are specific to your unit, so rely on your written pre-admission instructions.

• Arrange help at home for at least the first few days.

• Ask whether your dental check must be completed first.

• Bring a list of medicines, including any anticoagulant.

NHS.UK describes open heart surgery under general anaesthetic: a long cut down the centre of the chest through the breastbone, the heart connected to a heart-lung machine, the heart opened, the damaged valve removed and the new valve stitched in, the heart closed and restarted, and the breastbone closed with metal wires that are usually left in permanently. Keyhole surgery uses one larger and several smaller cuts and a camera, and recovery is usually quicker, but it is not always suitable.

For TAVI the page says you are awake with a sedative and local anaesthetic, a catheter is passed from the upper leg, arm or chest, and the new valve is fixed over the old one without stopping the heart or removing the old valve. After open or keyhole surgery you usually go to intensive care, with monitoring machines, oxygen, pain relief and chest tubes that come out after one or two days.

NHS.UK says some complications can be serious or life-threatening. It lists wound infection, bleeding that may need more surgery, heart rhythm problems that usually settle but sometimes need a pacemaker, kidney problems that are more likely if you already had kidney disease, blood clots or stroke, and problems with the new valve itself, since most last 15 to 20 years, or longer if mechanical. People at higher risk of clots may be given medicines for the first few weeks.

None of the pages read gave percentages for these problems, so none are quoted. Ask your surgeon for figures that reflect your own age, other conditions and operation.

Expect a chest wound, tiredness for the first few weeks and some pain in the chest, back or shoulders. NHS.UK says physiotherapists help you out of bed from the day after surgery, and you may be offered cardiac rehabilitation. The BHF says wound healing after open heart surgery is usually 8 to 12 weeks, during which you avoid strenuous activity such as carrying heavy bags. The linked timeline page sets this out in phases.

NHS.UK says to call your care team if the wound becomes more sore or red, bleeds or leaks pus, you have a high temperature or feel very hot or shivery, or you have palpitations. Call 999 or go to A&E for a throbbing, swollen, warm leg or arm, sudden breathlessness with sharp chest pain or coughing blood, or difficulty speaking, moving a limb or a drooping face. Do not drive yourself.

Ask which valve and approach are planned and why, what the alternatives are, what the unit's own results are, how long the valve is expected to last in your situation, how anticoagulation would be managed, and what follow-up scans are planned. Ask about dental care and antibiotics before future dental work.

NHS.UK says the operation is done in a specialist hospital. Heart valve surgery is available in both NHS and private specialist centres, and whichever route you take, the same questions about the surgeon's and unit's experience, intensive care provision and follow-up apply.