How Heart Valve Replacement Surgery Works — What Patients Need to Know

Heart valve surgery is one of the most common reasons patients from Africa travel to India for cardiac care. Rheumatic heart disease — valve damage from childhood streptococcal infections — affects large numbers of young adults across Ethiopia, Uganda, Tanzania, and Gambia, and the surgery that treats it is not consistently available in these countries.

Understanding what actually happens during valve surgery makes the decision to proceed much less daunting. The procedure is well-established, outcomes at high-volume centres are good, and for patients who need it, the improvement in quality of life is dramatic.

What Goes Wrong With Heart Valves

The heart has four valves: mitral, aortic, tricuspid, and pulmonary. Each opens and closes with every heartbeat, keeping blood flowing in one direction. When valves are damaged, two things can go wrong:

1. Stenosis — the valve thickens or calcifies and does not open fully. Blood cannot flow through properly. The heart works harder to push blood past the narrowed opening. Over time, the heart muscle thickens and eventually fails.

2. Regurgitation — the valve does not close properly. Blood leaks backwards with each heartbeat. The heart has to pump the same blood repeatedly. Again, over time, the heart dilates and fails.

Both conditions are progressive without treatment, and both cause breathlessness, fatigue, and eventually heart failure.

The most common cause of valve disease in African patients is rheumatic fever — an inflammatory response to untreated streptococcal throat infections in childhood. The inflammation damages the valve leaflets, causing them to scar, fuse, and stiffen over the following decades. Rheumatic mitral stenosis in a 30-year-old from Addis Ababa or Kampala is a common clinical presentation, and it is something India's cardiac surgeons see and operate on regularly.

Repair vs Replacement — The Most Important Decision

The first question the cardiac surgeon answers is whether the damaged valve can be repaired rather than replaced.

Repair means rebuilding the patient's own valve. The surgeon uses sutures, patches, rings, and various reconstructive techniques to restore normal valve function while keeping the patient's own tissue. No foreign body is implanted. No prosthetic device means no associated risks. Critically — in most cases — no need for lifelong anticoagulation.

For younger patients in particular, avoiding a mechanical valve and the lifelong blood-thinning medication it requires is a significant quality-of-life advantage. Warfarin needs regular INR monitoring. In countries where this monitoring is difficult to access consistently, the burden is real.

Whether repair is possible depends on the anatomy of the specific valve. Heavily calcified, scarred, or distorted valves may not be repairable. Some rheumatic mitral valves can be repaired; others cannot. The cardiac surgeon assesses this from the echocardiogram before surgery and makes a final intraoperative assessment on the table.

If repair is not feasible, replacement is the next step.

Types of Replacement Valves

1. Mechanical valves: Made of durable materials — typically carbon, titanium, and pyrolytic carbon. Last indefinitely. Require lifelong anticoagulation with warfarin and regular INR blood tests. The trade-off is a durable valve versus the burden and bleeding risk of permanent anticoagulation. Generally preferred in younger patients (under 50–55) where the valve's longevity matters more and the decades of anticoagulation are manageable.

2. Biological (tissue) valves: Made from animal tissue — typically porcine (pig) or bovine (cow) pericardium, treated and mounted on a frame. Do not require long-term anticoagulation. But they degrade over time — typically ten to fifteen years before structural deterioration requires reoperation or a transcatheter valve-in-valve procedure. Generally preferred in older patients where the valve lifespan is adequate for expected remaining lifespan, and in patients where anticoagulation compliance is a concern.

3. TAVI prostheses: Transcatheter valves deployed via catheter rather than open surgery — used for aortic stenosis in high-risk surgical patients or as a valve-in-valve in failing biological valves.

The Surgery — What Happens in the Operating Theatre

The patient is under general anaesthesia. The chest is opened via sternotomy. Cardiopulmonary bypass is initiated and the heart is stopped.

For mitral valve surgery, the surgeon approaches through the left atrium — the chamber on the other side of the mitral valve from the left ventricle. The leaflets are examined directly. If repair is attempted, the reconstructive work begins — repairing torn chords, resecting diseased leaflet segments, placing an annuloplasty ring to reshape and stabilise the valve annulus.

Once repair or replacement is complete, the heart is restarted. Before closing the chest, the valve function is assessed using intraoperative echocardiography — a probe placed in the oesophagus gives real-time images of the valve as the heart beats. If repair has left residual regurgitation above an acceptable threshold, replacement is done on the same table.

For aortic valve surgery, the approach is through the aorta. The diseased valve is excised and the new prosthetic valve is sewn into the aortic root.

Valve surgery typically takes three to five hours.

Recovery After Valve Surgery

Hospital stay: five to eight days for uncomplicated valve surgery. Patients start sitting up and walking on day two or three.

Before discharge, medication is established — anticoagulation if a mechanical valve was implanted, antiplatelet therapy if a biological valve, and heart failure medications if the heart was significantly dilated before surgery.

International patients at Prime Medical's partner hospitals remain in India for two to three weeks post-discharge for outpatient monitoring before the cardiac team clears flying.

Sternum healing takes six to eight weeks — lifting restrictions and driving restrictions apply during this period. Most patients return to normal activity by three months.

Cardiac Hospitals in Prime Medical's Network for Valve Surgery

Artemis Hospital, Gurugram (JCI, NABH) — Strong cardiac surgery department. Prime Medical partner. Good for mitral valve repair and replacement including rheumatic cases.

Fortis Memorial Research Institute, Gurugram (JCI, NABH, NABL) — High-volume valve surgery programme. TAVI available. Complex double and triple valve cases.

Max Super Speciality Hospital, Saket, Delhi (JCI, NABH, NABL) — Dr. Balbir Singh leads cardiology. Full valve programme. Treats African patients regularly.

Indraprastha Apollo Hospital, New Delhi (JCI, NABH) — Over 15,000 cardiac procedures annually. Africa desk. Full valve surgery capability.

For patients from Ethiopia, Uganda, Tanzania, and Gambia with rheumatic valve disease or other valve conditions: the first step is sharing your echocardiogram with Prime Medical Solutions. The cardiac surgeon reviews it within 48 hours and advises whether repair is likely achievable or whether replacement is the more appropriate approach — and which type of prosthetic valve makes sense for your age and circumstances.

To book a consultation, call the number on our website.