Cardiac Valve Surgery

There are four cardiac valves: tricuspid, pulmonary, mitral, and aortic. These structures let blood flow smoothly through the chambers of the heart, opening and closing as the heart beats. The valves open to let blood into a chamber and close tightly to prevent the backward flow of blood. The "lub-dub" sound of a heartbeat is made as the valves close.

Valve Problems

Damage from a heart attack, infection, or the aging process may cause the valves to stop functioning properly. A scarred or thickened valve (stenosis) may not open fully, increasing the heart's workload as it attempts to push the blood through a tight, restrictive valve. Another valve problem occurs when the valve does not close completely and blood is allowed to flow backwards. This is called insufficiency or regurgitation.

Valve Repair and Replacement

Operations to repair or replace poorly functioning heart valves are common procedures. In valve replacement, the surgeon decides whether a tissue valve or a mechanical valve would best correct the problem.

Surgeons often repair the valve rather than replacing it. Repair of the mitral valve is the favored option, but the choice of treatment is ultimately based on the individual and the degree or type of problem. In traditional heart valve surgery, the surgeon makes an incision down the center of the sternum (breastbone) to get direct access to the heart. The surgeon then repairs or replaces the abnormal heart valve or valves. Often, the surgeon or the anesthesiologist uses special echocardiography (transesophageal echo, or TEE) to monitor the function of the valve before, during, and after surgery.

In some cases, heart valves may be repaired or replaced through minimally invasive cardiac surgery. We perform two main types of minimally valve surgery at John Muir Health – one for the mitral valve, which controls blood flow between the upper and lower chambers of the heart, and the other for the aortic valve, which regulates blood flow from the ventricle, or lower chamber of the heart and aorta.

Transcatheter Aortic Valve Replacement (TAVR)

Approximately 1.5 million people in the United States suffer from severe aortic valve stenosis, often with debilitating symptoms that can restrict day-to-day activities, such as walking short distances or climbing stairs. These patients can often benefit from surgery to replace their ailing valve, but many patients are not treated because they are not suitable candidates for surgery, have not received a definitive diagnosis, or delay or decline the surgery for a variety of reasons. Patients who do not receive an aortic valve replacement have no effective, long-term treatment option to prevent or delay their disease progression.

For patients who are not able to have traditional open-heart surgery, a new procedure called transcatheter aortic valve replacement (TAVR) is now available as a treatment option. John Muir Health’s Concord Medical Center is one of only three hospitals in the Bay Area and less than 200 nationwide that is now performing TAVR procedures. In a TAVR procedure, the surgeon replaces the aortic valve in the heart via the femoral artery in the groin, thus eliminating the need for an open-heart surgery.

This remarkable new procedure provides the opportunity for a significant improvement in quality of life for patients For more information, call (925) 674-2858.

Transcatheter Mitral Valve Repair

Transcatheter mitral valve repair (TMVR) is approved for the treatment of significant, symptomatic mitral regurgitation (MR ≥ 3+ and a mitral valve area ≥4.0 cm2) due to primary abnormality of the mitral apparatus (degenerative MR). TMVR is indicated for patients who are at prohibitive risk for mitral valve surgery as determined by a heart team, which includes a cardiac surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease, and in whom existing comorbidities would not preclude the expected benefit from reduction of the mitral regurgitation.