• If you have mild heart valve disease, drug treatments to relieve symptoms (such as diuretics, ACE-inhibitors, and digoxin)
• Balloon valve surgery which can widen a narrowed valve (stenosis)

Your doctor will advise you which treatment is best for you.

What happens before surgery?
Your surgeon will discuss how to prepare for heart valve surgery.

For example if you smoke, you may be advised to give up as smoking increases the risk of chest infection and slows the healing of wounds as well as increasing the risk of blood clots in the legs.

What should I expect in hospital?
Heart valve surgery usually requires around five to seven days in hospital.
The operation will be performed under general anesthetic so you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anesthetic. However, some anesthetists allow occasional sips of water until two hours beforehand.

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. This is a good time to ask any unanswered questions about the operation.

The Operation
The length of your operation will depend on whether your valve is to be repaired or replaced and how many valves are going to be treated - your surgeon will advise you how long the operation will take.

Heart valve surgery is carried out under a general anesthetic, which means that you will be asleep throughout the procedure and will feel no pain.

The surgeon will make a cut, about 25cm (10") long, down the middle of your breastbone (sternum) and will open your ribcage to reach your heart.

Medication is used to temporarily stop your heart. Your blood will be re-routed to a heart-lung (bypass) machine. This will take over from your heart and lungs, and will add oxygen to your blood and maintain your circulation.

The diseased valve will then be replaced or repaired.

Valve replacement
Your surgeon will remove your diseased valve and sew in a replacement prosthetic (artificial) valve. There are two types.

• Mechanical valves are artificial manufactured valves. They are made of carbon fiber which is a hard material. Sometimes they make a clicking sound but most people soon get used to this. Mechanical valves have the advantage of lasting a long time - usually a lifetime. However there is a risk that a blood clot can form on the valve so you will need to take blood thinning drugs (anticoagulants), such as warfarin, for the rest of your life to avoid this. Your doctor will give you more advice about these drugs.
• Biological valves are made from human or animal tissue (usually pig). You will probably not need to take anticoagulants for the rest of your life but your surgeon may recommend them for the few weeks after the operation while the valve settles in. You may need further surgery every 10-15 years because biological valves can wear out faster than mechanical valves. Biological valves are not suitable for everybody - your doctor will advise you whether they are the best choice for you.

Instead of making a cut down the sternum, the operation is performed through small incisions. Special instruments are passed through the small incisions and the surgeon uses a video monitor to see the inside of your chest. These methods are not suitable for all patients - your surgeon will advise you if they are suitable for you.

After the operation
After heart valve surgery, you will be taken to the intensive treatment unit (ITU) of the hospital and will be closely monitored for a day or two before you go back to your ward.
When you wake up from the anesthesia, you will be connected to machines that record the activity of your heart, lungs and other body systems. These might include a ventilator machine to help you breathe. You may also have between two and four wires, called pacing wires, inserted near the chest drains. These are used to control your heart rate if necessary after the operation. These will be removed three or four days after your operation.

You will be given painkillers to help relieve any pain and discomfort as the anesthetic wears off.

A physiotherapist will usually visit you every day to help you do exercises designed to help your recovery.

Before discharge, your nurse will give you advice about caring for your wounds, diet and exercise, and will give you medicines to take home with you. You should tell your Physician when you are discharged from hospital so he or she can provide the care you need.

Recovering from heart valve surgery
At home, take painkillers if needed, as advised by your surgeon or nurse.
If you have questions about what you can and can't do, ask your surgeon or nurse for guidance.

The wires holding your sternum together are usually permanent, but the stitches closing the wound will gradually dissolve. The sternum takes about six weeks to heal.

You shouldn't drive until you can perform an emergency stop without discomfort.

When you see your surgeon for a follow-up appointment, he or she will advise you about when you can resume other activities such as returning to work. A full recovery can take two to three months.

Deciding to have heart valve surgery
For most people, the benefits of having heart valve surgery are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects are the unwanted but mostly temporary effects of a successful procedure. For heart valve surgery, side-effects include:

• Discomfort around the operation site for a few weeks
• A scar down the length of your sternum - the scar will be red at first but should fade over time

• Blood clots may form, particularly if you have had a mechanical valve fitted.
• These clots can break off and block an artery (blood vessel), which can lead to a heart attack or stroke. Anticoagulant medicines will help to prevent this happening.
• The valve may wear out or be damaged, particularly tissue valves in young, more active people.
• It's possible that you may have an irregular heart beat (arrhythmia), which can be treated with drugs and is usually temporary.
• Your new valve can become infected and inflamed (endocarditis). This can damage your heart. You will be given antibiotics to help lower this risk.
• There is a small risk of death during or soon after this operation.