For the heart to pump effectively, its valves must open fully to allow blood to flow forward and then close completely to prevent backflow. If these valves leak or don't allow free passage of blood, it leads to increased workload on the heart. Heart valves, each a marvel of nature, sometimes fail to perform their mechanical functions due to various diseases. In such cases, cardiac valve problems are solved through surgical intervention. The most frequently repaired valves, with highly successful outcomes, are those located between the atria and ventricles. The valve between the right atrium and ventricle is called the tricuspid valve, and the one on the left is the mitral valve. Heart valve disease is most commonly treated with valve replacement surgery. During surgery, the diseased valve is removed, repaired, or replaced with a mechanical or biological valve.

However, not all heart valves are repairable. In valve disease caused by rheumatic diseases, the thickening and calcification due to increased connective tissue in the valve tissue limits the possibility of repair. On the other hand, very successful results are obtained in cases of valve insufficiency arising from causes such as dilation of the valve annulus, prolapse or lengthening of a part of the valve, or valve leaflet prolapse. Mitral valve insufficiency can also result from a heart attack. Following a heart attack or endocarditis (heart infection), the rupture of one of the chordae tendineae supporting the mitral valve or thinning of the heart wall (aneurysm) where it attaches impairs valve function. In these patients, valve repair is also necessary in addition to coronary bypass surgery.

The target durability of valve repairs is 10 years or more. During and after surgery, the structure and function of the heart valves can be assessed in detail using a transesophageal echocardiography (TEE) device placed in the esophagus. In this process, the experience of the surgeon and team, as well as the anesthesiologist and cardiologist performing the echocardiographic examination, plays a significant role. This makes it possible to verify the success of the surgery before the patient leaves the operating room.

Heart valve prostheses have certain weaknesses compared to the heart's native valves. Mechanical valve prostheses, also known as metal valves, require the use of anticoagulant medication to reduce blood clotting. Without these medications, clot formation on the valve and the risk of this clot breaking off and disrupting circulation to various organs exists. For example, disruption of brain circulation can lead to a stroke. Bioprosthetic valves, also known as tissue valves, require medication for a shorter period (3-6 months). However, the weakness of these valves is that they can undergo calcification and degeneration within about 10 years.

Another negative aspect of replacing the mitral or tricuspid valve with a prosthetic valve is the severing of the muscles and fibers that anchor these valves to the heart base. Severing these muscles, which facilitate the opening and closing of the heart valve and also play a role in heart contraction, affects the heart's performance. Therefore, if valve repair is possible and is expected to maintain physiological conditions long-term, it is much better than valve replacement.

After valve repair, a certain amount of time is needed for the tissue to cover the suture ends in the repaired area of the heart and the ring-shaped prosthesis often placed to support the repair. This period varies from 3 to 6 months. During this period, anticoagulants are used to prevent clot formation on the prosthesis and suture ends. Blood tests should be performed at intervals determined by the cardiologist, at least once a month, to assess the effectiveness of this medication. Recent advancements in home devices for INR testing have greatly simplified the management of this medication. After this period, an annual checkup by a cardiologist and echocardiography control will suffice.