Heart Valve Repair & Replacement Surgery & Cost

Heart valve surgery is done to fix or replace a heart valve that isn't working properly. When a valve is too narrow or leaks, it can affect how blood flows through the heart. To help the heart work normally again, doctors may use various surgical procedures. The main heart valve surgery types include:



Types of heart valve repair surgery procedures

Surgeons often prefer valve repair when possible, as it preserves the patient's native valve tissue and may reduce the need for long-term blood-thinning medication. Heart valve surgical repair includes:

• Annuloplasty: This technique reinforces the valve annulus (a fibrous ring that anchors the valve leaflets) with a prosthetic ring to reduce dilation and improve leaflet closure. This technique is commonly used in mitral and tricuspid regurgitation.
• Valvuloplasty (balloon valvotomy): Balloon heart valve surgery is a minimally invasive, catheter-based procedure that uses a balloon to widen a narrowed valve opening. It is effective for mitral or pulmonary stenosis in noncalcified cases.
• Leaflet repair: It is a surgical or transcatheter procedure used to fix the leaflets (flaps) of a heart valve, most commonly the mitral valve, when they are damaged and not closing properly, which leads to regurgitation.
• Commissurotomy: It is a surgical repair of a heart valve that cuts or separates commissures (fused points) of a heart valve, most often the mitral valve, to relieve stenosis and improve blood flow.
• Transcatheter mitral valve repair: This is a catheter-based technique that clips together parts of the mitral valve to reduce leakage. It is recommended for patients with severe mitral regurgitation who are not suitable candidates for open-heart surgery.
  

Types of Heart Valve Replacement Surgery

The surgeon performs heart valve replacement surgery when the valve is too damaged to repair. The heart valve replacement types are: 

• Mechanical valves: Mechanical heart valve replacement is the procedure that replaces the diseased valves with mechanical valves that are made of durable materials such as carbon and titanium. But mechanical valve surgery of the heart requires lifelong anticoagulation to prevent blood clots, which increases bleeding risk. They are recommended for younger patients or those already on long-term anticoagulation.
• Biological valves (tissue heart valve replacement): Biological heart valve replacement is the procedure in which the diseased heart valves are replaced with implants made from animal tissue or human tissue. They function more naturally and usually do not require long-term anticoagulation. These valves are suitable for older adults or those unable to take blood thinners, though they may wear out over time and require future replacement.
• Autografts (Ross procedure): In this, the diseased aortic valve is replaced with the patient’s own pulmonary valve and roots. The removed pulmonary valve is then replaced with a donor human valve (a homograft or allograft) 
• Transcatheter aortic valve replacement (TAVR): A less invasive procedure used mainly for severe aortic stenosis. A new valve is placed through a catheter inserted via the groin or chest, avoiding open-heart surgery.

Heart Valve Surgery Indications

This surgery is considered for patients with significant or progressive valvular heart disease that affects normal cardiac function. These interventions are suggested when medical therapy is unable to control symptoms or when structural valve abnormalities pose a risk of heart failure, arrhythmias, or other complications. Below are some of the conditions where heart valve surgery is recommended:

• Severe aortic stenosis
• Severe aortic insufficiency/regurgitation
• Severe mitral regurgitation
• Symptomatic patients with heart failure signs
• Severe tricuspid regurgitation
• Congenital valve defects

Severe aortic stenosis: This occurs when the aortic valve becomes extremely narrow, restricting blood flow from the heart to the rest of the body. This forces the heart to pump harder, eventually weakening the heart muscle. When symptoms such as chest pain, breathlessness, fainting, or reduced exercise capacity appear, surgery becomes necessary. Valve repair or replacement restores normal blood flow and prevents heart failure from getting worse.

Severe aortic insufficiency/regurgitation: In severe aortic insufficiency, the aortic valve cannot close completely, allowing blood to leak back into the left ventricle. This backward flow increases the workload on the heart, leading to left ventricular enlargement and reduced pumping strength.

Severe mitral regurgitation: Severe mitral regurgitation occurs when the mitral valve fails to close properly, which allows blood to flow backwards into the left atrium. This increases pressure in the lungs and causes symptoms such as fatigue, shortness of breath, and irregular heartbeat. If untreated, it can lead to heart enlargement and heart failure. Surgical repair or replacement is recommended to prevent long-term complications and improve heart function.

Symptomatic patients with heart failure signs: Patients who experience heart failure symptoms—such as shortness of breath, swelling of the legs, fatigue, or reduced activity tolerance—may need valve repair or replacement if the underlying cause is a diseased valve. When valve dysfunction leads to poor blood flow and increased pressure in the heart, correcting the valve problem becomes essential.

Severe tricuspid regurgitation: Leg swelling, ascites, fatigue, and right heart failure result from severe tricuspid regurgitation, which causes blood to backflow from the right ventricle to the atrium. Surgery (annuloplasty repair) is recommended for severe symptomatic TR or left-sided valve disease.

Congenital valve defects: Congenital valve defects are structural abnormalities present from birth that can interfere with normal blood flow. These defects may cause narrowing, leakage, or abnormal valve movement as the child grows or as an adult ages. When these abnormalities lead to symptoms or risk of complications, valve repair or replacement becomes necessary to ensure proper blood circulation and protect long-term heart health.

This surgery is effective for managing significant valvular disease, but it may not be appropriate for every patient. Certain medical, anatomical, or systemic conditions can increase surgical risk or limit the likelihood of a successful outcome. The key contraindications for heart valve surgery are:

Absolute contraindications

• Active infections
• Severe bleeding disorders

Relative contraindications

• Estimated life expectancy <1 year
• Inability to tolerate anticoagulation therapy
• Inadequate anatomy for specific approaches
• Severe comorbidities
• Severe aortic or vascular calcification
• Pregnancy or desire for future pregnancy
• Absence of a multidisciplinary heart team

Absolute Contraindications

These are conditions where the surgery should not be performed because the risks are too high or the outcome is unlikely to improve. These conditions are:

• Active infections: Active endocarditis (heart valve infection) makes surgery very risky because bacteria can spread during the procedure or infect the new valve. Surgery is usually postponed until the infection is brought under control by using antibiotics.
  
• Severe bleeding disorders: Patients with uncontrolled coagulopathy or severe bleeding disorders are at an extremely high risk of intraoperative and postoperative haemorrhage. Therefore, performing surgery on these patients can be life-threatening due to bleeding complications.

Relative Contraindications

These elevate risks but may allow surgery after risk-benefit assessment:

The estimated life expectancy is less than 1 year: If a patient has another serious medical condition that limits life expectancy to less than a year, the benefits of valve surgery may not outweigh the risks. In such cases, treatment usually focuses on symptom control and improving comfort.

Inability to tolerate anticoagulation therapy: A patient who undergoes heart valve replacement mechanically may require lifelong anticoagulation. Patients unable to tolerate anticoagulation due to bleeding risks, compliance issues, or contraindications cannot safely receive mechanical valve replacement. Even for biological valves, short-term anticoagulation is often needed. Without anticoagulation, the risk of valve thrombosis and stroke is very high.

Inadequate anatomy for specific approaches: Some patients have structural limitations (such as small valves, distorted valve structures, or damaged surrounding tissues) that make repair or replacement technically impossible. In such cases, the surgeon may consider alternative procedures or medical management.

Severe comorbidities: Conditions such as advanced lung disease, severe liver failure, renal failure, or uncontrolled cancers can make major heart surgery extremely risky. In these situations, surgery is avoided.

Severe aortic or vascular calcification: Extensive calcium deposits in the aorta or major blood vessels make surgical access difficult and increase the risk of complications. These patients may require alternative approaches such as TAVR instead of open surgery.

Pregnancy or desire for future pregnancy: Mechanical valve replacements usually require lifelong anticoagulants, which are unsafe in pregnancy. Even biological valves carry higher risks due to the stress pregnancy places on the heart. Women who are pregnant or planning pregnancy must be evaluated carefully to avoid harm to both mother and baby.

Absence of a multidisciplinary heart team: Coordinated care from cardiologists, cardiac surgeons, cardiac anesthesiologists, and imaging specialists is necessary for heart valve replacement and repair surgeries. If such a team is not present, the risk of complications increases significantly, making the procedure unsafe.

Benefits of Heart Valve Surgery

Heart valve surgery steps include the following:

Before heart valve surgery

• Medical evaluation and preoperative tests: Before surgery, the doctor conducts a thorough medical assessment, including a detailed medical history and a full physical examination. Patients need to discuss with the doctor any history of bleeding disorders. Additional tests such as blood work, ECG, echocardiography, X-ray, CT scan, or cardiac catheterisation may be required to check heart function.
• Signing the consent form: Before surgery, the doctor needs to explain everything about the procedure, and after the explanation patient is asked to sign a consent form to authorise the surgical team to perform the procedure. 
• Allergies or sensitivities: Patients need to inform the doctor if they are sensitive to or allergic to any medications, tape, latex, or anaesthetic agents (local and general).
• Medication history: Patients need to inform the doctor about every medication they take, including prescription medications, anticoagulants (blood-thinning medications), OTC drugs, vitamins, and herbal supplements. Use of blood-thinning medications may need to be stopped several days before the procedure to reduce bleeding risk.
• Informing about pregnancy: Female patients who are pregnant or suspect they might be pregnant need to tell the doctor. 
• Fasting instructions: Patients are usually advised not to eat or drink anything for eight hours before the procedure. 
• Lifestyle and pre-surgery preparation: Doctors may also advise patients to stop smoking, limit alcohol, follow a heart-healthy diet, and complete pre-operative dental checks.
  
  

During heart valve surgery

• Anaesthesia and monitoring: This procedure is done under general anaesthesia, as the patient must remain entirely unconscious and immobile. The anesthesiologist will continuously monitor heart rate, blood pressure, breathing, and blood oxygen levels all the time during surgery for patient stability. Once the patient is sedated completely, a breathing tube is inserted and connected to a mechanical ventilator during the procedure.
• Surgical access: Depending on the surgery being performed incision is made. For open heart surgery, the surgeon makes a midline incision extending from just below the Adam's apple to above the navel. And for minimally invasive procedures, smaller incisions are used.
• Valve assessment: Once the heart is accessed, the surgeon opens the affected chamber and examines the damaged valve. The anatomy is evaluated to decide whether repair or replacement will give the best long-term outcome.
• Surgical Technique: The surgical technique selected depends on the valve involved and the severity of the disease. Two major categories are:
• Heart valve repair procedure is performed based on the valve (mitral, aortic, or tricuspid). The surgical repair heart valve involves reshaping or reinforcing the valve leaflets, removing excess tissue that causes leakage, repairing or replacing torn valve cords, and tightening or supporting the valve ring with an annuloplasty ring. Repair helps keep the patient's natural valve structure and function.
• Heart valve replacement surgery procedure is performed if the valve is severely damaged; in this procedure, the valve is removed and replaced with either a mechanical or biological (tissue) valve. The new valve is securely stitched in place to ensure proper opening and closing with each heartbeat.
  
• Intraoperative care: Following surgery, the heart is slowly restarted, and the heart-lung machine's support is eventually withdrawn. The team closely examines heart rhythm, pumping function, and valve function. Surgeons monitor hemostasis and surrounding tissues such as the coronary arteries and conduction pathways to ensure their safety. They also make sure the valve is properly aligned and securely placed, using absorbable materials. The incisions are closed with sutures or staples.

After heart valve surgery

• Recovery room & ICU monitoring: After surgery, patients are taken to the intensive care unit (ICU) for close monitoring. Here, patients' vital signs, heart rhythm, breathing, blood pressure, and oxygen levels are continuously observed. Chest tubes, IV lines, and temporary pacing wires may be used depending on the procedure.
• Pain management: Pain is managed using IV or oral pain medicines. Discomfort usually decreases within a few days. Patients are encouraged to practice breathing exercises and use an incentive spirometer to reduce the risk of lung complications.
• Fluid and wound management: Chest drainage tubes are monitored and removed once drainage decreases. Incisions on the chest must be kept clean and dry. 
• Activity restrictions: Patients are encouraged to walk early but must avoid lifting heavy objects, pushing or pulling objects and raising arms above shoulder level excessively.
• Hospital stay: Most patients stay in the hospital for 5 to 7 days, depending on their recovery and the type of surgery.
• Follow-up visits: Patients are advised to follow up within 1–2 weeks after discharge. These visits involve incision checks, adjusting medications, and conducting echocardiograms to evaluate valve function after the surgery.
  

Like any major surgical procedure, heart valve repair and replacement surgery also has a risk of complications that can impact long-term results as well as short-term recovery. The following are some of the heart valve surgery risks: 

• Bleeding
• Infection at the incision site
• Blood clots and stroke
• Valve-related issues
• Arrhythmias
• Breathing problems
• Anaesthesia risks
  
  

Bleeding: It can occur during or after surgery because the heart and major blood vessels are involved. Patients who use blood thinners or have bleeding disorders may be at higher risk. Sometimes additional medicines or blood transfusions may be required to control the bleeding.

Infection at the incision site: The surgical wound on the chest may become infected, causing redness, warmth, pain, or discharge. In rare cases, the infection can spread deeper to the breastbone or even to the heart valve. Proper wound care and antibiotics help prevent and treat these infections.

Blood clots and stroke: Blood clots may form after valve surgery, especially in patients who receive a mechanical valve and need lifelong anticoagulation. If these clots travel to the brain, they may cause a stroke.

Valve-related issues: It may occur with the repaired valve or the new replacement valve may not function as expected. This may cause leakage, narrowing, or stiffness. Tissue valves may wear down, and mechanical valves may develop clot-related problems.

Arrhythmias (irregular heartbeats): Irregular heart rhythms, especially atrial fibrillation, are common after valve surgery. They may cause palpitations, dizziness, or tiredness. 

Breathing problems: After surgery, some patients may experience shortness of breath, lung congestion, or pneumonia. This may occur due to anaesthesia, pain restricting deep breathing, or fluid buildup. 

Anaesthesia risks: General anaesthesia can lead to temporary side effects like nausea, a sore throat, low blood pressure, or allergic reactions. Serious complications are uncommon. Anaesthesiologists keep a close watch on patients during the procedure to ensure their safety.

• Heart valve repair surgery recovery time starts in the hospital, where patients are encouraged to start basic activities early. This may reduce complications and improve healing. 
• After discharge, most recovery takes place at home about 4–8 weeks, although the timeline may vary depending on the type of surgery (such as open or minimally invasive) and overall health of the patient. 
• During the recovery time, patients may feel tired and must pace themselves, while gradually increasing activity and avoiding lifting heavy objects or strenuous work. 
• Regular follow-up, usually around 6 to 8 weeks after surgery, is essential to monitor heart function, adjust medications, and guide return to daily routine. 
• The long-term recovery from surgery involves adopting heart-healthy habits, adherence to the medications as prescribed and following a recovery plan to regain strength and protect long-term heart health.
  

Questions that patients can ask about heart valve surgery to the health care team?

• Is valve repair possible, or do I need a valve replacement?
• Which type of replacement valve (mechanical or biological) is best for me and why?
• How long will the procedure take?
• What should I expect on the day of surgery?
• What are the possible risks and complications of this surgery?
• When can I return to work, exercise, or daily activities?
• Will I need to take lifelong medication, especially blood thinners?
• What lifestyle changes should I make after surgery?
• What is the expected success rate for this surgery?

Heart valve repair vs Valve replacement

The cost of Heart Valve Surgery in Hyderabad generally ranges from ₹2,30,000 to ₹5,80,000 (approx. US $2,770 – US $6,990).

The exact cost of heart valve surgery varies depending on factors such as the type of valve involved (mitral, aortic, tricuspid, or pulmonary), whether valve repair or valve replacement is required, the type of valve used (mechanical or tissue/bioprosthetic), the surgical approach (open heart surgery or minimally invasive/thoracoscopic techniques), patient risk profile, surgeon expertise, ICU stay, and hospital facilities — including cashless treatment options, TPA corporate tie-ups, and assistance with medical insurance wherever applicable.



Cost Breakdown According to Type of Heart Valve Surgery

• Mitral Valve Repair Surgery – ₹2,30,000 – ₹4,20,000 (US $2,770 – US $5,060)
• Mitral Valve Replacement – ₹2,80,000 – ₹5,20,000 (US $3,375 – US $6,265)
• Aortic Valve Replacement (AVR) – ₹3,00,000 – ₹5,80,000 (US $3,615 – US $6,990)
• Mechanical Valve Replacement – ₹2,70,000 – ₹4,80,000 (US $3,255 – US $5,780)
• Tissue / Bioprosthetic Valve Replacement – ₹3,20,000 – ₹5,80,000 (US $3,855 – US $6,990)
• Minimally Invasive / Thoracoscopic Valve Surgery – ₹3,00,000 – ₹5,50,000 (US $3,615 – US $6,630)
• Redo / Revision Heart Valve Surgery – ₹3,80,000 – ₹5,80,000 (US $4,580 – US $6,990)
  

What is the recovery for heart valve replacement?

Many patients stay in the hospital for 5 to 7 days after open-heart valve replacement and for 2 to 3 days after TAVR. Full recovery usually takes 6 to 12 weeks. Patients gradually return to walking, breathing exercises, and their normal daily activities. Doctors often recommend cardiac rehabilitation to support recovery. Follow-up visits help ensure that the new valve is working properly.

What is tricuspid heart valve replacement surgery?

This is a surgical procedure that helps to replace a damaged tricuspid valve with a mechanical or tissue valve to restore normal blood flow between the right atrium and the right ventricle. This surgery improves cardiac function and alleviates symptoms caused by valve dysfunction.

What is heart valve replacement through the groin?

Heart valve replacement through the groin refers to a less invasive procedure called transcatheter valve replacement. In this procedure, a catheter is introduced into the femoral artery in the groin and guided to the damaged heart valve, where a new valve is placed without opening the chest.

How long does a heart valve replacement last?

A heart valve replacement lasts 10 to 20 years, depending on valve type and patient factors. Tissue valves from animals tend to last about 10 to 15 years, while mechanical valves generally last longer but require lifelong blood-thinning medication.

How many times can a heart valve be replaced?

Heart valves can be replaced multiple times as needed, though successive replacements increase complexity and risk. The number of times depends on the patient's health, the type of valve, the reason for replacement, and surgical risks. Repeat valve replacement, called reoperation, that is considered when valves become dysfunctional.

What is leaky heart valve repair?

Leaky heart valve surgery, also called valve regurgitation repair, is a procedure that fixes a valve that does not close tightly, allowing blood to flow backwards. Repair may involve tightening the valve ring, reshaping valve flaps, or adding a support band.

How is congenital heart valve repair performed?

Congenital heart valve repair is a surgical procedure to correct heart valve defects present from birth. This repair improves blood flow, preserves heart function, and is preferred in children to support natural growth and delay the need for valve replacement.

What is the prognosis of heart valve repair?

The prognosis for heart valve repair is generally excellent when performed before major cardiac damage occurs. Studies shows that, repaired valves often last longer and have fewer long-term issues than replacement valves. Patients usually experience major improvement in breathing, exercise capacity, and quality of life. Regular follow-up and heart-healthy lifestyle habits help maintain good outcomes.

How painful is heart valve surgery?

Heart valve surgery involves some pain and discomfort, especially in the first few days after the operation. Pain is commonly felt at the chest incision site and during movement or coughing. However, pain is well controlled using modern pain-relief methods, including medications and supportive care. Discomfort usually decreases steadily over weeks.

Can someone live a normal life after heart valve surgery?

Most people can return to a normal and active life after heart valve surgery. Symptoms such as shortness of breath and fatigue generally improve after recovery. Many people can resume regular activities, work, and exercise with medical guidance. Long-term success is dependent on regular check-ups, prescribed medications, and healthy lifestyle habits.

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