The two most common valves that require surgery are the aortic valve and the mitral valve. The aortic valve is subject to life-long stress and may become narrowed (stenotic) with age. A stenotic aortic valve will require replacement with a prosthetic valve. Less commonly, the aortic valve will leak (insufficiency or regurgitation). In this situation, the valve can sometimes be preserved with operations that reconstruct the valve leaflets and surrounding structures.
The mitral valve is more likely to develop insufficiency (leaking) over time due to conditions such as mitral valve prolapse or stretching/elongation of the valve support system. Surgical repair is highly effective, allowing preservation of the mitral valve and reducing or eliminating the amount of leakage. Mitral valve stenosis is less common and usually requires replacement with a prosthetic valve.
Operations that repair heart valves include valve-sparing aortic root replacement, mitral valve repair, and robotic heart valve surgery. Valve repair surgery is best performed before the heart sustains permanent damage or heart failure. These operations are generally preferred for younger patients in order to preserve the native valve.
When valve replacement is required, a prosthetic valve is selected. Patients desiring to avoid anticoagulation can select aortic valve replacement with a tissue valve. Mechanical valves are durable but require daily blood-thinning medications. Certain patients will be candidates for human valve replacement, also known as homografts. Factors to consider when selecting a valve replacement include level of activity, possibility of future operations, desire to avoid anticoagulation, and the underlying cause of the valvular heart disease.