When all of the sutures have been positioned around the annulus they are extended through the sewing ring on the prosthesis. Then they are uniformly tightened to position the valve in the annulus. After the sutures are tightened, the surgeon inspects her work to make sure that blood won't leak around the valve. Then each suture is carefully tied using multiple knots and the extraneous lengths of suture are cut off. When the surgeon is convinced that the valve replacement has been successful, the left atrium is sutured back together.
Some blood is released into the heart to check for leaks.
Once the surgeon is satisfied, air bubbles are purged from the heart and the patient is taken off of heart-lung bypass. The patient is closed back up and sent to recovery. After surgery, the patient is often put on anticoagulant medication to minimize the risk of stroke or heart attack. A small amount of bleeding may occur at the incision due to these blood-thinning drugs that limit the blood's ability to clot, and is normal. Assuming that the patient is otherwise healthy, discharge usually occurs in a few days.