Heart valve replacement is done one of two main ways: traditional open-heart surgery, where a surgeon cuts through the breastbone to access the heart directly, or a catheter-based approach, where a new valve is threaded through a blood vessel (usually in the groin) and guided into place without opening the chest. The method used depends on which valve needs replacing, your age, overall health, and surgical risk level.
Open-Heart Valve Replacement
In traditional surgery, the process begins with general anesthesia. Once you’re asleep, the surgeon makes an incision down the center of the chest and separates the breastbone (a procedure called a sternotomy) to reach the heart. You’re then connected to a heart-lung machine, which takes over pumping blood and supplying oxygen so the surgeon can stop the heart temporarily and work on it in a still, bloodless field.
With the heart stopped, the surgeon removes the damaged valve and sews the new one into place using sutures anchored into the tissue ring where the old valve sat. Once the new valve is secure and tested, the heart is restarted, you’re disconnected from the heart-lung machine, and the breastbone is wired back together. The entire operation typically takes two to four hours.
A minimally invasive version of this surgery exists as well. Instead of splitting the full breastbone, the surgeon works through a smaller incision, either a partial cut through the upper breastbone or a small opening between the ribs. The valve replacement itself is the same, but the smaller incision can mean less blood loss and a somewhat faster recovery. That said, these approaches are technically more demanding, and not every patient or every hospital offers them.
Catheter-Based Replacement (TAVR)
Transcatheter aortic valve replacement, commonly called TAVR, avoids opening the chest entirely. It’s used primarily for the aortic valve and was originally developed for patients too frail for open-heart surgery, though it’s now used in a wider range of patients.
The procedure starts with a small puncture in the femoral artery near the groin. A thin, flexible catheter carrying a compressed replacement valve is threaded up through the artery, past the aorta, and positioned inside the diseased valve. Imaging tools guide the catheter the entire way. Crossing the narrowed native valve with a wire requires precision; sometimes the heart is paced rapidly for a few seconds to reduce its motion and allow the wire to pass through.
Once the catheter is in position, the new valve is deployed. With balloon-expandable valves, the surgeon inflates a small balloon that pushes the new valve open, pressing the old valve leaflets aside. The balloon stays inflated for only about three seconds. Self-expanding valves, by contrast, are released from a sheath and spring open on their own using the memory of a special metal alloy. Either way, the new valve begins working immediately, and the catheter is withdrawn back through the artery. Most TAVR procedures take about an hour.
Mechanical vs. Biological Valves
Before surgery, you and your doctor will choose between two types of replacement valves, and this decision shapes your life after the procedure as much as the surgery itself.
Mechanical valves are made from engineered materials like pyrolytic carbon, titanium, and polymers. Their major advantage is durability: they can last a lifetime. The tradeoff is that blood tends to form clots on artificial surfaces, so you’ll need to take a blood-thinning medication (warfarin) every day for the rest of your life. That means regular blood tests to make sure the medication level stays in the right range, and a higher risk of bleeding from injuries or even minor cuts.
Biological (bioprosthetic) valves are made from animal tissue, most commonly from pig heart valves or cow heart sac tissue, mounted on a metal or polymer frame. They don’t require lifelong blood thinners in most cases, only a short course in the first few months after surgery while the new valve surface heals over. The downside is that biological tissue gradually wears out. In a large study following patients aged 65 to 80 for an average of about 13 years, 5.2% of those with biological valves needed a second operation by year 12, compared with 2.3% of those with mechanical valves. That gap widened after seven to eight years of follow-up. Younger patients saw even higher reoperation rates: among those aged 65 to 69, about 10.5% eventually needed their biological valve replaced.
Current guidelines generally favor mechanical valves for patients under 50 (for aortic valves) because durability matters more over a longer lifespan. Biological valves are typically recommended for patients over 65, since the valve is likely to outlast the patient and they avoid the burden of lifelong blood thinners. For patients in between, it comes down to personal preference, lifestyle, and how willing you are to commit to regular blood monitoring.
Tests Before Surgery
Before any valve replacement, your medical team needs a detailed picture of the valve damage and the surrounding anatomy. The cornerstone test is an echocardiogram, which uses ultrasound to show how the valve opens and closes, how much blood is leaking backward, and how well the heart muscle is pumping. This can be done from outside the chest (transthoracic) or with a small probe passed down the throat (transesophageal) for a closer look.
If TAVR is being considered, a CT scan of the heart and blood vessels is essential. It maps the exact size and shape of the valve, the width of the arteries the catheter will travel through, and the position of nearby structures that could complicate the procedure. In some cases, cardiac catheterization is also used to measure pressures inside the heart chambers directly.
What Recovery Looks Like
After open-heart surgery, you’ll wake up in the intensive care unit with a breathing tube, chest drainage tubes, and monitoring lines. Most people spend three to seven days in the hospital total. The breastbone needs about six to eight weeks to heal, and during that time you’ll be told to avoid lifting anything heavy, driving, or pushing and pulling motions that stress the chest. Most people return to work somewhere between six and twelve weeks after surgery, depending on how physically demanding their job is.
Recovery from TAVR is dramatically shorter. Because there’s no chest incision or breastbone to heal, many patients go home within one to three days and are back to normal activities within a couple of weeks.
Regardless of the approach, the early weeks involve cardiac rehabilitation, which is a structured program of gradually increasing exercise, education on heart-healthy habits, and monitoring. It makes a measurable difference in how quickly you regain strength and confidence.
Risks and Complications
All heart valve replacements carry some risk of stroke, infection, irregular heart rhythms, and bleeding. Wound infections at the incision site can occur after open surgery but are typically treatable with antibiotics. Some patients develop an irregular heartbeat after the procedure; this often resolves within a few days, but if it persists, a pacemaker may be needed. The risk of needing a pacemaker is higher with TAVR than with open surgery, particularly with self-expanding valve designs.
Stroke risk is elevated in the first three to six months after any valve replacement while the new valve surface is still healing. This is one reason blood thinners or aspirin are prescribed during that window even for biological valves.
Long-Term Medication After Replacement
If you receive a mechanical valve, you’ll take warfarin for life. Your blood’s clotting ability will be checked regularly to keep it in a target range. For a mechanical valve in the aortic position, doctors aim for a specific clotting measurement (INR) of 2.0 to 3.0. For a mechanical valve in the mitral position, the target is slightly higher, 2.5 to 3.5, because blood clots form more easily there.
If you receive a biological valve, the picture is simpler. Most patients take warfarin or a similar blood thinner for only the first three months, then transition to low-dose aspirin alone. The exception is if you also have an irregular heart rhythm like atrial fibrillation, in which case longer-term blood thinners are needed regardless of valve type.