What to know about the recovery time for a heart valve replacement through the groin

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The heart consists of four chambers: two upper chambers called the atria and two lower chambers called the ventricles. A wall of tissue called the septum separates the four chambers.

Four heart valves help to pump blood through the four chambers. They are:

• The aortic valve: This valve sits between the left ventricle and the aorta. The aorta is the large artery that carries oxygenated blood from the heart to the rest of the body.
• The mitral valve: This valve sits between the left atrium and the left ventricle.
• The pulmonary valve: This is between the pulmonary artery and the right ventricle. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs for oxygenation.
• The tricuspid valve: This valve sits between the right atrium and right ventricle.

Various heart conditions can cause damage to the heart valves. According to the Centers for Disease Control and Prevention (CDC), around 2.5% of the population in the United States has some form of valvular heart disease. If damage to the heart valve is severe, a doctor may recommend an HVR.

Below are some conditions that may require an HVR.

Stenosis

The term stenosis refers to a narrowing of the valve opening. This narrowing makes it difficult for blood to flow through the valve efficiently.

Stenosis can develop if the flaps inside the valve do not form properly before birth. Medical professionals refer to these “flaps” as leaflets or cusps. Stenosis can also occur due to calcification and rheumatic fever.

Any valve can develop stenosis, but it occurs most frequently in the aortic valve.

Regurgitation

Heart valve regurgitation occurs when a valve does not close or seal tightly, causing blood to leak backward instead of moving forward. This backflow of blood causes the heart to work less efficiently.

Most cases of regurgitation are due to mitral valve prolapse (MVP). In MVP, part of one or both leaflets of the mitral valve bulge upward into the left atrium.

Regurgitation can also be congenital, meaning a person is born with irregularly shaped valve flaps or openings.

Atresia

Atresia is a condition in which one of the heart’s valves does not develop, causing blood to take an alternative route between two chambers. This alternative route typically consists of a hole between the two chambers.

Atresia is usually present from birth but may occasionally develop later in life.

According to the National Heart, Lung, and Blood Institute (NHLBI), there are two main types of atresia: pulmonary and tricuspid.

• Pulmonary atresia (PA): In PA, blood cannot flow from the heart to the lungs.
• Tricuspid atresia (TA): In TA, blood cannot flow from the right atrium to the right ventricle.

Surgeons can perform a valve replacement through traditional open heart surgery or a transcatheter procedure.

A transcatheter procedure involves putting the replacement valve into a tube and threading the tube through a large artery in the groin. While surgeons usually perform this procedure through the groin, they can use another access point in the body if needed.

Procedures that require a groin incision for a valve replacement include the following:

• Transcatheter aortic valve replacement: A procedure to replace the aortic valve in cases of aortic insufficiency or stenosis.
• Transcatheter mitral valve replacement: A procedure to replace the mitral valve in cases of mitral valve stenosis or regurgitation.
• Transcatheter pulmonary valve replacement: A procedure to replace the pulmonary valve in cases of pulmonary valve stenosis.
• Transcatheter tricuspid edge-to-edge repair: A procedure to repair the tricuspid valve in cases of tricuspid regurgitation.

The potential recovery time for an HVR varies according to several factors, including:

• the type of valve that needs replacing
• the person’s age
• whether the person has any underlying medical conditions

According to the NHLBI, individuals will generally need to stay in the hospital overnight or for several days following the procedure, depending on various factors. However, they can typically return to their usual daily activities in as little as a few weeks.

Complications

As with all types of surgery, complications may slow recovery. The most common complications from an HVR through the groin include:

• valve leakage
• stroke
• kidney injury
• bleeding
• heart block, which is an impairment of the electrical signal within the heart

Other risks may include heart attack or death.

The recovery time following a complication varies according to the type of complication and the individual’s response to treatment.

Nonetheless, the American Heart Association (AHA) states that HVR through the groin generally has more advantages than traditional open heart surgery. These advantages include:

• a lower risk of infection
• a reduced hospital stay
• decreased recovery time
• less trauma to the chest and heart tissue

Outcomes

In an older 2016 study, HVR through the groin resulted in better 3-year outcomes compared to traditional open heart surgery for severe aortic stenosis.

The following factors may help to improve recovery after an HVR:

• following the doctor’s advice
• taking prescription medications
• getting enough rest
• following recommendations for exercise
• quitting smoking, if applicable
• following a heart-healthy diet
• attending regular checkups

It is vital that a person speaks with a doctor before deciding whether an HVR through the groin is the best option for them. The doctor can answer questions to help the person decide on their treatment options.

A person should also maintain good communication with the doctor after an HVR procedure. Doing so enables the doctor to assess the person’s recovery and to detect and treat any surgical complications in their early stages.

Anyone who experiences signs of a complication following an HVR should contact a healthcare professional urgently.

A heart valve may need replacing due to damage, disease, or a congenital anomaly. One option is to replace the valve through the groin. This procedure may result in fewer complications and a quicker recovery than traditional open heart surgery.

It is important that a person talks with the doctor about the potential risks and benefits of HVR surgery through the groin. People who undergo the procedure should also maintain regular contact with the doctor throughout the recovery process to help minimize the risk of complications.

Anyone concerned about HVR before or after the procedure should contact their doctor for further advice.