Quick answer
What Is Heart Valve Surgery?
Heart valve surgery is an operation to repair or replace a heart valve that is narrowed or leaking so that blood flows in one direction again. A valve that cannot be repaired is replaced with a mechanical or biological valve. The operation usually takes 3 to 5 hours under general anesthesia with the help of a heart-lung machine.
Sources01 / Understanding the procedure
About Heart Valve Surgery
What Is Heart Valve Surgery
The heart has four valves: the mitral, aortic, tricuspid, and pulmonary valves. These valves open and close with every heartbeat so that blood flows in one direction. A valve can become narrowed (stenosis), making it hard to open, or leaky (regurgitation), letting blood flow backward. Both make the heart work harder and over time can lead to heart failure or heart rhythm disorders.
Heart valve surgery is an operation to repair a damaged valve or replace it with an artificial valve. One operation can treat more than one valve.
Repair or Replacement
When possible, the surgeon repairs the original valve, for example by reshaping the valve leaflets, placing artificial supporting cords, or placing a ring to reduce the circumference of the valve. Repair is usually chosen for leaking mitral and tricuspid valves, covered on the Mitral Valve Repair page. If the valve is too damaged, for example because of severe calcification or rheumatic heart disease, the valve is replaced.
Artificial Valve Options
Mechanical valves are made of durable man-made materials, but people who have them need to take warfarin for life with regular INR tests, covered on the Anticoagulation Therapy and Stroke Prevention page. Biological valves are made from animal tissue and usually do not require lifelong blood thinners, but they can wear out after many years and may eventually need further treatment.
The choice of valve is discussed with your doctor, taking into account your age, pregnancy plans, bleeding risk, ability to have regular blood tests, and your own preferences.
How the Surgeon Reaches the Heart
The operation is usually done through an incision in the middle of the chest by dividing the breastbone (sternotomy). In certain patients, the surgeon may use a smaller incision on the side of the chest or open only part of the breastbone, covered on the Minimally Invasive Heart Surgery page. During the operation, a heart-lung machine takes over the work of the heart and lungs so that the heart can be stopped temporarily.
Surgery or a Catheter Procedure
Some valve diseases can now be treated through a catheter, for example narrowing of the aortic valve, covered on the Transcatheter Aortic Valve Implantation (TAVI) page. The decision between surgery and a catheter procedure is made by the heart team, made up of a cardiologist, a cardiac surgeon, and a cardiac imaging specialist, together with you and your family.
The team weighs your age, surgical risk, the shape of the valve, other heart conditions that need surgery at the same time, and your preferences. Surgery is often preferred in younger people, when the valve can be repaired, or when several heart problems need to be treated at once.
02 / Understanding the procedure
When Is This Procedure Considered?
A doctor may consider this procedure in the situations below. The decision is always made after a thorough assessment.
- Severe Aortic StenosisNarrowing of the aortic valve that causes symptoms or is starting to weaken the heart's pumping.
- Severe Mitral or Aortic Valve LeakageEspecially when it causes symptoms, reduced pumping function, or a left ventricle that keeps getting larger.
- Rheumatic Heart DiseaseA narrowed or leaking mitral or aortic valve caused by rheumatic fever in the past.
- Heart Valve InfectionEndocarditis with severe valve damage, an infection that is hard to control, or a risk of clots breaking loose.
- Problems with a Previous Artificial ValveAn artificial valve that is worn out, stuck because of a clot, leaking around its edge, or infected.
- Together with Other Heart SurgeryA valve with significant problems can be treated at the same time as coronary bypass or aortic surgery.
Situations to Consider First
- Valve Disease Not Yet SevereMild to moderate abnormalities without symptoms are usually monitored periodically with echocardiography.
- Very High Surgical RiskWhen your general condition is very weak, a catheter procedure or medication may be more suitable.
- Very Little Expected BenefitWhen another serious illness makes it unlikely that surgery will improve symptoms and quality of life.
- Active Infection Elsewhere in the BodyFor planned surgery, infections of the teeth, skin, or urinary tract are usually treated first.
03 / Before the procedure
How Should You Prepare?
Planned valve surgery is preceded by several visits and tests. The surgical team, your cardiologist, and the anesthesia team give you instructions suited to your condition.
Heart tests. Echocardiography to assess the valves and the heart's pumping function, sometimes supplemented by transesophageal echocardiography through the esophagus. Examination of the coronary arteries with angiography or CT is usually done at certain ages or when there are risk factors for coronary artery disease.
Other supporting tests. Blood tests, an ECG, a chest X-ray, and lung function tests if needed help assess whether your body is ready for surgery and general anesthesia.
Teeth and sources of infection. Have your teeth checked and treated before surgery, because germs from the teeth and gums can attach to the artificial valve.
Medications. Bring a complete list of your medications and supplements. Warfarin, clopidogrel, or other blood thinners may need to be stopped or switched several days beforehand. Do not stop any medication on your own without your doctor's instructions.
Choosing the type of valve. Discuss the possibility of repair or replacement, as well as the choice between a mechanical and a biological valve, before the day of surgery.
Quitting smoking, fasting, and consent. Stop smoking as early as possible. Follow the fasting instructions from the anesthesia team. Your doctor explains the purpose, benefits, risks, and other options before you sign the consent form. Arrange for a family member who can accompany you during your hospital stay.
Unsure about the preparation instructions? Ask our team before the procedure.
04 / During the procedure
How Is the Procedure Done?
Heart valve surgery is performed by the cardiac surgery team in the operating room under general anesthesia. Surgery on one valve usually takes 3 to 5 hours, and it can take longer if several valves or other heart problems are treated at the same time. The team will keep your family informed during and after the operation.
General Anesthesia and Monitoring
After you are asleep, the anesthesia team places a breathing tube, IV lines, a blood pressure monitoring line, and a urinary catheter. A transesophageal echocardiography probe is passed through the mouth into the esophagus to monitor the heart and valves during the operation.
Opening the Chest and the Heart-Lung Machine
The surgeon makes an incision in the middle of the chest, or a smaller incision in certain patients. Blood flow is diverted to the heart-lung machine, and the heart is then stopped temporarily with a special solution.
Repairing or Replacing the Valve
The surgeon opens the heart or the aorta to reach the valve. The valve is repaired when possible, or the damaged leaflets are removed and an artificial valve is sewn onto the original valve ring.
Restarting the Heart and Closing the Chest
Air is removed from the heart, the heart is restarted, and the heart-lung machine is gradually disconnected. Valve function is checked with echocardiography. Drainage tubes and temporary pacing wires are placed, the breastbone is joined with wires, and you are then moved to the ICU.
05 / Benefits and risks
Benefits and Risks Should Be Discussed Together.
Every medical procedure has benefits and risks. Your doctor will explain both for your situation before the procedure.
Benefits You Can Expect
- Blood Flows in One Direction AgainA repaired or replaced valve stops the narrowing or leakage that was straining the heart.
- Symptoms Can EaseShortness of breath, tiring easily, and leg swelling can improve after the recovery period.
- Protecting Heart Pumping FunctionSurgery at the right time helps prevent the heart muscle from enlarging and weakening further.
- Several Problems Treated at OnceMore than one valve, coronary bypass, or the aorta can be treated in a single operation.
The benefits of a procedure are not a promise of a cure. Ask how the results will affect your care plan.
Risks You Should Know
- BleedingBleeding after surgery may require a transfusion and, in a small number of patients, repeat surgery.
- Heart Rhythm DisordersAtrial fibrillation is fairly common after surgery; some patients need a pacemaker.
- StrokeClots, air, or debris can travel to the brain during or after surgery.
- InfectionInfection can occur in the wound, breastbone, lungs, or artificial valve and may require prolonged treatment.
- Problems with the Artificial ValveA clot on a mechanical valve, a worn biological valve, or leakage around the valve that needs treatment.
- Other Serious ComplicationsKidney or lung problems and, in a small number of patients, death; your doctor explains the estimated risk.
Risks can differ from person to person. A full explanation and consent are given after an individual assessment.
06 / After the procedure
What Is Recovery Like?
Recovery happens gradually. The length of your hospital stay depends on your age, your condition before surgery, the number of valves treated, and whether there are any complications.
In the ICU and the ward. Usually about 1 to 2 days in the ICU, followed by care on the ward. You start sitting up, walking, and practicing deep breathing with help from nurses and physiotherapists. The total hospital stay is usually about 5 to 7 days.
After going home. The breastbone needs about 6 to 8 weeks to heal. During that time, avoid lifting heavy objects, pushing, or pulling hard, and ask your doctor when you can drive. A supervised exercise program is covered on the Structured Cardiac Rehabilitation Program page.
Medications and follow-up visits. People with a mechanical valve take warfarin for life with regular INR tests. People with a biological valve or a repair ring may need a blood thinner or an antiplatelet medication in the first months. Follow-up echocardiograms are done according to the schedule from your doctor.
Protecting the valve from infection. Keep your teeth clean and have regular dental checkups. Tell your dentist that you have an artificial valve, because certain dental procedures require preventive antibiotics.
Warning signs. Contact the medical team right away or go to the emergency room if you have:
- Fever, or a surgical wound that becomes redder, more swollen, oozes pus, or opens
- New chest pain, shortness of breath, or an irregular, pounding heartbeat
- Facial drooping, weakness on one side of the body, or slurred speech
- Bleeding that is hard to stop, widespread bruising, or black stools while taking a blood thinner
- Leg swelling or rapid weight gain within a few days
- A mechanical valve click that changes or cannot be heard as usual
Know the Signs That Need Prompt Care.
Follow the team's guidance on warning signs. If severe or sudden symptoms appear after the procedure, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
07 / Team and support
Doctors and Procedure Support
The doctors below are listed for this procedure. Listed by name, not by ranking.
Dr. dr. Dudy A. Hanafy, Sp.BTKV, Subsp. JD(K), MARS
Adult Cardiac Surgery
Advanced Cardiovascular Surgical Care +1 center
Clinical focusMinimally Invasive Cardiac Surgery · Coronary Artery Bypass Surgery
View Profile
dr. Rr. Pasati Lintangella, Sp.BTKV
Thoracic & Cardiovascular Surgery
Advanced Cardiovascular Surgical Care +1 center
Clinical focusAdult Cardiac Surgery · Coronary Artery Bypass Surgery
View Profile
dr. Salomo Purba, Sp.BTKV, Subsp.JPK(K)
Pediatric and Congenital Heart Surgery
Congenital and Structural Heart Center +2 centers
Clinical focusPediatric Heart Surgery · Congenital Heart Defect Surgery
View ProfileOperating Theatre (Cardiac Operating Room)
An operating room dedicated to heart and blood vessel surgery, where the surgical, anesthesia, perfusion, and nursing teams work…
Minimally Invasive Cardiac Surgery (MICS) Technology
A way of performing heart surgery through a small incision between the ribs or through part of the breastbone, using long-shafted…
Live Surgery Facility
Cameras and an audio-video link in the operating room that allow an operation to be broadcast for education and discussion among…
Cardiovascular Intensive Care Unit (ICU)
An intensive care unit for heart and blood vessel patients who need close monitoring and prompt treatment, for example after…
The availability of technology and test support is confirmed with the team. Technology is chosen according to clinical need.
08 / Common questions
Before You Plan the Procedure.
Questions patients and families often ask before heart valve surgery.
What is the difference between a mechanical valve and a biological valve?
A mechanical valve is made of durable man-made materials, but people who have one need to take warfarin for life with regular INR tests. A biological valve is made from animal tissue and usually does not require lifelong blood thinners, but it can wear out after many years and may need to be replaced or treated again. Your doctor helps you weigh the options based on your age and life plans.
Can my valve be repaired instead of replaced?
It depends on which valve is damaged and the type of damage. Leaking mitral and tricuspid valves can often be repaired, while a heavily calcified aortic valve or a valve badly damaged by rheumatic heart disease is more often replaced. The final decision is made by the surgeon after seeing the valve directly during surgery, with the help of echocardiography.
What is the difference between valve surgery and TAVI?
In valve surgery, the chest is opened and the valve is repaired or replaced directly with the help of a heart-lung machine. In TAVI, a new aortic valve is inserted through a catheter from a blood vessel without opening the chest. TAVI is only for the aortic valve and is generally chosen more often in older age. The choice is made by the heart team together with you, and TAVI is covered on the Transcatheter Aortic Valve Implantation (TAVI) page.
Is valve surgery painful?
During surgery you are asleep under general anesthesia, so you do not feel anything. Afterward, pain in the chest wound, shoulders, or back is normal for a few days to weeks and is controlled with pain medication. Coughing and deep breathing may feel uncomfortable; holding a pillow against your chest helps. Tell the nurse if pain disturbs your sleep or your exercises.
When can I return to work and drive?
The breastbone needs about 6 to 8 weeks to heal, so driving and heavy lifting are usually postponed during that time. Many people can return to light work after about 6 to 8 weeks, while heavy physical work takes longer. If the operation was done through a small incision, recovery may be faster. Your doctor decides the timing at your follow-up visit.
Do I need antibiotics before seeing the dentist?
People with an artificial valve, including a repair ring made of man-made material, have a higher risk of valve infection. Preventive antibiotics are recommended before certain dental procedures, such as tooth extraction or cleaning of tartar below the gums. Always tell your dentist that you have an artificial valve, keep your teeth clean, and have regular dental checkups.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Widya T. Suwatri, Sp.BTKV, Subsp. JD(K).
Sources as cited in the Indonesian edition.
- Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025;46(44):4635-4736.
- Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.
- Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227.
- Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med. 2017;377(19):1847-1857.
- Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042.
- Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation. 2021;143(20):e963-e978.