By Dr. Asher George Joseph
MBBS, M.Ch (CTVS • Gold Medalist), MRCS (Edinburgh), FACS (USA)
Fellowship – Heart & Lung Transplantation & Mechanical Circulatory Support
Manchester, UK
Introduction: When the Heart’s Doors Stop Working
Your heart has four valves, and each works like a perfectly timed gate.
Every second, they open and shut ~100,000 times, allowing blood to flow in the right direction.
But what happens when one of these tiny gates becomes tight (stenosis), leaky (regurgitation), weak, or damaged?
You feel it —
- breathlessness
- fatigue
- swelling
- chest pressure
- reduced stamina
- fainting spells
And slowly, life starts shrinking.
Valve Repair and Valve Replacement Surgeries are the medical world’s equivalent of precision engineering — restoring the heart’s “doors” and bringing life back to full rhythm.
🔍 What Exactly Goes Wrong with Valves?
Before we talk about treatment, let’s understand the problem:
1️⃣ Stenosis – The Valve Becomes Too Tight
Like a jammed door, the valve refuses to open fully → less blood flow → heart works harder.
2️⃣ Regurgitation – The Valve Becomes Leaky
The valve doesn’t close properly → blood leaks backward → causing heart enlargement.
3️⃣ Congenital Valve Defects
Some people are born with abnormal shapes of valves — bicuspid aortic valve is the most common.
4️⃣ Infection (Endocarditis)
Bacteria damage the valve tissue, making it dysfunctional.
5️⃣ Age-Related Calcification
The valve becomes stiff due to calcium deposits over decades.
Whatever the cause, the endpoint is the same → reduced pumping, symptoms, and risk of heart failure.
🛠️ Heart Valve Repair: Fixing What Already Exists
Valve repair is always preferred whenever possible — because nothing beats your own natural tissue.
✔ Advantages of Valve Repair
- No long-term blood thinners
- Better durability in many cases
- More natural heart function
- Lower chance of infection
- Shorter recovery
That’s why expert surgeons like Dr. Asher George Joseph, trained in minimally invasive and transplant-grade cardiac surgery, always evaluate for repair first.
👉 Types of Valve Repairs (Explained Simply)
1️⃣ Annuloplasty – Tightening the Valve
A ring (band) is placed to reshape and support the valve.
2️⃣ Leaflet Repair – Fixing the Flaps
Torn, stretched, or prolapsed leaflets are stitched or reshaped.
3️⃣ Chordae Repair – Replacing the Broken Strings
Artificial chords (neochords) are added to support the valve leaflets.
4️⃣ Commissurotomy – Opening a Fused Valve
The fused portions of a stenotic valve are gently separated.
5️⃣ Patch Repair
A small patch is used to close abnormal openings.
Repair is mostly done for:
🫶 Mitral Valve
🫶 Tricuspid Valve
Aortic valve repairs are more complex but possible in selected cases.
🔁 When Repair Isn’t Enough → Valve Replacement
Sometimes the valve is too calcified, destroyed, or deformed, making repair impossible.
That’s where Valve Replacement Surgery becomes life-saving.
You can choose between:
1️⃣ Mechanical Valves (Metal Valves)
⚙️ Extremely durable – last a lifetime
⚠️ Require lifelong blood thinners (warfarin)
Ideal for younger patients.
2️⃣ Bioprosthetic Valves (Tissue Valves)
🧬 Made from cow/pig heart tissue
🧘 No long-term blood thinners
🕰️ Lasts 12–18 years
Ideal for older adults, women planning pregnancy & those who cannot take anticoagulants.
🌐 The Rise of Minimally Invasive Valve Surgery (Keyhole Surgery)
In Bangalore, minimally invasive valve surgery is becoming the new gold standard — especially in centers like where Dr. Asher practices.
✨ Benefits:
- 5–7 cm incision instead of full chest cut
- Less pain
- Faster recovery
- Better cosmetic outcome
- Reduced hospital stay
- Faster return to routine
This approach demands high surgical expertise, advanced imaging, and specialized equipment — all available in leading cardiac centers in Bangalore.
🚀 TAVR/TAVI – No Open Surgery Needed
For high-risk or elderly patients, the aortic valve can be replaced through a small puncture in the leg artery.
No chest cut.
No bypass machine.
Discharge in 48–72 hours.
This is revolutionizing treatment for:
- Aortic stenosis
- High-risk surgical patients
And Bangalore is now a major hub for these advanced procedures.
🏥 The Surgical Journey – What Patients Experience
A surgery is not just a procedure — it’s an emotional journey.
Here’s what the path looks like:
1️⃣ Pre-Surgery Evaluation
- Echo
- CT scan
- Coronary angiogram
- Lung & kidney assessment
- Anaesthesia evaluation
Customized planning helps predict outcomes with remarkable accuracy.
2️⃣ The Procedure
Depending on the case:
- Minimally invasive approach
- Robotic-assisted where suitable
- Open-heart surgery
- TAVR/TAVI
- Combined procedures (CABG + valve repair)
Dr. Asher’s team follows a “Heart Team Approach” — meaning cardiologists, surgeons, and anesthesiologists plan the procedure together.
3️⃣ Recovery Timeline
✔ ICU: 1 day
✔ Ward: 3–5 days
✔ Back to routine life: 3–4 weeks (minimally invasive)
✔ Full recovery: 6–8 weeks
Patients typically notice:
- Better breathing
- More energy
- Improved sleep
- Ability to walk longer distances
❓ Frequently Asked Questions (FAQs)
1. Is valve repair better than replacement?
Yes, where possible. Repair preserves your natural valve, avoids blood thinners, and offers better long-term function.
2. How long does a replaced valve last?
- Mechanical valves: 20–30+ years
- Tissue valves: 12–18 years (sometimes 20+)
3. Will I need blood thinners after surgery?
Only if you have:
- A mechanical valve
- Atrial fibrillation
- Specific risk conditions
4. Is minimally invasive surgery safe?
Absolutely — in experienced hands.
It is now widely used for mitral and aortic valve procedures.
5. When should someone consider valve surgery?
If you have:
- Severe symptoms
- Worsening echo parameters
- Heart enlargement
- Breathing difficulty
- Aortic stenosis with dizziness/fainting
6. Can both valves be repaired/replaced in one surgery?
Yes. Double valve surgeries are routinely done in advanced cardiac centers.
🩺 Final Message
Valve repair & replacement surgeries are life-transforming, not just life-saving.
With modern techniques — especially in expertise-driven cities like Bangalore — patients recover faster, live longer, and enjoy a significantly better quality of life.
If you or your loved one has been diagnosed with valve disease, remember:
The earlier the treatment, the better the heart’s recovery.
