Alternativesto heart valve replacement

There may be alternatives to heart valve replacement, depending on your condition.

Your alternatives to surgery will depend on the type of valve that’s affected and the problem with the valve.

Watchful waiting

If your valve problem isn’t too severe, your GP or cardiologist may recommend a 'watchful waiting' approach, using medications to compensate for the valve that isn’t working properly, regular check-ups and echocardiograms (ultrasounds of the heart).

Medication

In some cases, medication can be taken to help reduce the symptoms associated with a narrowed or leaky valve. These may include:

• ACE inhibitors to open blood vessels, reducing blood pressure, and slow the effects of heart failure
• Anti-arrhythmic medications to help restore the normal pumping rhythm when your heart isn’t beating properly
• Anticoagulants to help reduce the risk of blood clots from poorly circulating blood
• Beta-blockers to reduce the workload on your heart and can lessen the feeling of palpitations
• Diuretics to lower the workload on your heart by reducing the amount of fluid that it has to pump
• Calcium channel blockers to open and relax blood vessels, reduce blood pressure and encourage blood flow.

If you wait too long to have surgery, your heart muscle may become damaged. This could impact your recovery after surgery or mean that you’re unable to have the surgery at all.

Heart valve repair

If your heart valve isn’t too badly damaged, or is damaged in a particular way, you may be able to have it repaired and strengthened, rather than replaced. There are several ways your surgeon can repair a valve without the need for open surgery.

Balloon valvotomy

This procedure can relieve a narrowed valve (with stenosis) and is often used on the mitral valve. A small catheter holding a collapsed balloon is threaded through an artery from your groin and placed inside the valve. Then the balloon is expanded, stretching the valve open.

Percutaneous mitral valve leaflet repair

A tiny clip is attached to the damaged part of your mitral valve, closing it tightly, so the rest of the valve can still open and close normally. The clip is used to minimise the amount of blood that regurgitates through the valve. To place the clip, the valve is accessed through a vein in your groin. This procedure is most commonly used for people who aren’t well enough for open heart surgery but is starting to be used more widely as the technology for the repair improves.

Other procedures for repairing valve defects

Options include procedures to thicken or reshape the valve leaflets, remove calcium build-up from the leaflets, repair the cords that support the valves and patch holes or tears in the valve leaflets.

An alternative heart valve replacement procedure

While most heart valve replacements are performed as open surgery, there’s a less invasive procedure where your surgeon replaces or repairs the valves through a catheter inserted in a vein. It’s called transcatheter aortic valve implantation (TAVI). There’s also improving technology which allows mitral valves to be treated in the same way.Your cardiologist will talk to the cardiac surgeon and other cardiologists to assess which procedure is best for you.