Aortic Valve Repair and Aortic Valve Replacement Procedures
Overview
The aortic valve is one of the four key valves in the heart. It sits between the lower left chamber and the aorta, the main artery that carries blood to the rest of the body. The aortic valve works with other heart valves to keep blood moving in the right direction.
Normal Aortic Valve Function:
- Opens when the heart contracts
- Allows blood to flow from the lower left chamber to the aorta
- Closes when the heart relaxes to prevent blood from moving backward
When disease or damage affects the aortic valve, it disrupts blood flow, making the heart work harder and leading to symptoms or complications tied to heart valve disease.
Reasons for Aortic Valve Surgery:
- Improve blood flow
- Reduce symptoms linked to heart valve disease
- Help the heart work more efficiently
Surgeons can perform aortic valve repair and replacement as open-heart surgery or with minimally invasive methods. These treatments support heart function and can extend a person’s lifespan by addressing the underlying valve problem.
Main Methods
Doctors use several ways to fix or replace heart valves. The main approaches include annuloplasty, which tightens or reshapes the ring around a valve, and valvuloplasty, where a balloon opens a narrowed valve.
Other options include mechanical valves, made from durable materials, and biological valves from human or animal tissue. Surgeons may use open-heart methods or less invasive procedures like TAVR (transcatheter aortic valve replacement).
Common Procedures:
- Aortic valve replacement
- Mitral valve repair or replacement
- Heart valve repair
- Valve replacement surgery
A table summarizing the types:
| Type | Description |
|---|---|
| Annuloplasty | Shapes or strengthens valve ring |
| Valvuloplasty | Uses balloon to widen valve |
| Mechanical valve | Made of synthetic, lasting material |
| Biological valve | Made from tissue |
| TAVR (Transcatheter method) | Minimally invasive valve replacement |
These methods help restore normal blood flow and improve heart function.
Reasons for the Procedure
Doctors perform aortic valve repair or replacement to address several health issues linked to the aortic valve. These problems can make it hard for the heart to pump blood efficiently to the rest of the body. Here are some common reasons this surgery is needed:
Types of Aortic Valve Disease
| Condition | Description |
|---|---|
| Aortic Valve Regurgitation | The valve does not close tightly, letting blood move backward into the lower left chamber. |
| Aortic Valve Stenosis | The valve flaps become thick or stiff, limiting how well they open and close. |
| Congenital Valve Defects | Babies may be born with valves that are shaped wrong or have the wrong number of flaps. |
Aortic valve regurgitation can result from damage or an abnormal valve structure since birth. Aortic valve stenosis may develop due to a condition present at birth or from infections that impact the valve.
Doctors may recommend surgery to fix valves that are blocked, leaking, or shaped abnormally. By correcting these problems, the heart can work better and symptoms like shortness of breath or fatigue can improve.
Possible Complications
Aortic valve repair or replacement can lead to different problems. A person’s overall health, the exact surgical method, and the skill of the medical team all influence the chances of complications.
Common Risks
- Bleeding
- Blood clots
- Issues with the new or repaired valve
- Abnormal heart rhythms (arrhythmias)
- Infection
- Stroke
Receiving care from a hospital with an experienced heart surgery team lowers the chances of serious problems. Each risk may affect people differently, and some can be life-threatening if not managed properly.
Getting Ready for Your Surgery
Eating, Drinking, and Taking Medicine
Before aortic valve surgery, a healthcare team provides step-by-step instructions about eating, drinking, and medication. Patients should ask when to stop eating or drinking the evening before the operation. Patients need to find out which daily medicines to take or avoid before arriving at the hospital, especially if doctors will use general anesthesia.
People should also tell their care team about any allergies or past reactions to medications. Keeping an updated list of all current medications helps the staff make decisions and prevent issues during surgery.
Quick Tips
- Do not eat or drink anything unless told otherwise.
- Share all medication and allergy information with your care provider.
- Ask if you need to stop any medicines before surgery.
What to Bring and Wear
Packing personal items makes the hospital stay more comfortable. Patients should bring a current list of their medications, eyeglasses, hearing aids, or dentures if needed, along with everyday items like a toothbrush, a comb, or a shaving kit.
Soft, easy-to-wear clothing is recommended for when it’s time to go home. If there is an advance directive or legal wishes for treatment, bringing a copy is useful. Comfort objects, like portable music players or books, can be added for relaxation.
| Not Allowed During Surgery |
|---|
| Contact lenses |
| Dentures |
| Eyeglasses |
| Jewelry |
| Nail polish |
Patients should make sure these items are removed before going in for surgery to avoid any issues.
What you can expect
Steps to Take Before Surgery
People getting ready for aortic valve surgery will have certain preparations. Staff usually shave the area on the body where the surgical cut will happen to cut down the risk of infection. Special liquids or soaps clean the skin before the procedure.
Doctors explain the process, what to expect, and answer any questions. Patients may need to stop eating or drinking for a certain period before the operation. Staff give instructions about any medication adjustments. Everyone is checked for any possible problems before the surgery begins. A list of common pre-surgery steps:
- Shaving: Body hair near the chest is removed.
- Skin Cleaning: Special soap is applied to reduce infection.
- Fasting: No food or drink for hours before surgery.
- Medical Checkup: Review of health and current medications.
- Consent: Signing forms to agree to the surgery.
Doctors and nurses provide encouragement and guidance at every stage. The patient may meet members of the surgical team, including the cardiovascular surgeon and anesthesia specialist.
What Happens While the Surgery Is Being Done
When surgery begins, anesthesia medicine puts the patient to sleep and prevents pain. The medical team closely watches the heart rate, blood pressure, and breathing. Most aortic valve operations use a heart-lung bypass machine to keep blood and oxygen moving through the body while the heart is stopped during surgery.
Types of Surgical Approaches
| Approach | Description | Key Features |
|---|---|---|
| Open-heart surgery | Large incision down the center of chest. | Involves sternotomy; access to heart and aortic root. |
| Minimally invasive surgery | Small incisions without major bone cutting. | Less pain, shorter stay, and quicker recovery. |
| Transcatheter technique (TAVR) | Catheters navigate the delivery of the valve replacement through an artery. | No open chest procedure is necessary for specific patients. |
Details of the Surgery
Doctors use two main treatments: repair and replacement. Each one depends on the damage or condition of the aortic valve.
Aortic Valve Repair
- Surgeons sometimes perform repair through open-heart surgery by opening the chest bone (sternotomy).
- The surgeon may patch up small holes or tears, separate any stuck valve flaps, trim tissue, reinforce the valve base (aortic root), or reshape the ring around the valve (annulus).
- After open-heart operations, wires hold the chest bone together for healing.
Minimally Invasive Valve Repair
- Surgeons make small injuries or scars instead of a large cut.
- In some cases, doctors use balloon valvuloplasty. A thin, flexible tube called a catheter is placed in an artery of the arm or groin.
- A balloon on the tip inflates at the aortic valve to stretch it open, then deflates and is removed.
- This technique is more common in children and patients who cannot have open surgery.
Aortic Valve Replacement
- If the valve cannot be fixed, the surgeon replaces it.
- The surgeon removes the old valve and puts in a new one, which can be mechanical or made from tissue (pig, cow, or human heart).
- A unique method, called the Ross procedure, uses the person’s own lung (pulmonary) valve to replace the diseased aortic valve.
- Surgeons may perform replacement by open-heart surgery or with less invasive methods.
Transcatheter Aortic Valve Replacement (TAVR)
- TAVR is a form of minimally invasive heart surgery.
- Surgeons use long catheters to place a new biological valve inside the heart, through a blood vessel.
- No major cutting or bone breaking is needed.
- TAVR is a common choice when patients are not good candidates for open surgery.
Comparison Table – Repair and Replacement
| Aspect | Repair | Replacement |
|---|---|---|
| Invasiveness | Open or minimally invasive | Open or minimally invasive |
| Recovery | Varies; often shorter with minimally invasive | Similar with both methods |
| Valve used | Original valve fixed | Mechanical or tissue valve |
No matter the approach, a cardiovascular surgeon with specialized training leads the surgical team. Staff closely monitor numerous processes using advanced machinery.
What Recovery Is Like After Surgery
After surgery finishes, recovery starts in a hospital setting. The length of the stay depends on the type of heart procedure and how each person responds.
Typical Features of Hospital Recovery:
- IV lines provide fluids and medicines.
- Tubes help drain fluids or urine from the body.
- Oxygen is given by mask or small nasal tube if needed.
- Nurses and doctors check for signs of infection, monitor blood pressure, heart rate, and breathing.
- Pain is treated with medicine as needed.
Getting Back on Your Feet
Movement is important, so nurses help the patient get out of bed and walk as soon as it is safe. Walking and simple exercises help prevent problems like blood clots and lung issues.
Breathing exercises and coughing keep the lungs clear. The care team watches for infection, healing of the incision, and works to manage pain. A sample daily routine in the hospital may include:
- Checking vital signs several times a day.
- Walking small distances with help.
- Doing breathing exercises to strengthen lungs.
- Having the surgical sites checked and cleaned.
- Eating light meals as approved by doctors.
Typical Recovery Timeline
| Event | Timeframe |
|---|---|
| Hospital stay | Few days to a week |
| Chest bone healing (if opened) | 6–8 weeks |
| Gradual return to normal activity | Several weeks to a few months |
Recovery at home continues after leaving the hospital. Most people will have regular follow-up visits, do light activities, and slowly increase their strength. Special care prevents incision infection. Doctors may prescribe medicines to control blood pressure, prevent blood clots (if a mechanical valve is used), and manage discomfort.
Patients should report any unusual symptoms, like fever, chest pain, or trouble breathing, to a doctor right away. Patients often receive written instructions, a schedule for new medications, and appointments for cardiac rehabilitation or checkups.
Main Recovery Steps After going home
- Follow all care instructions from the surgical team.
- Watch for signs of problems like fever or swollen wounds.
- Take medication as directed by the doctor.
- Attend all follow-up appointments.
- Resume light activities and slowly increase movement.
Completing recovery and returning to normal activities may take a few months, depending on the procedure and individual health. Support from healthcare professionals, family, and friends is important during this time.
Surgery Results and Ongoing Management
After aortic valve repair or replacement, doctors typically give patients instructions on when they can resume normal activities. For several weeks, most people should not drive or lift heavy objects, especially anything over 10 pounds. Routine appointments help doctors monitor the function of the new or repaired valve.
Doctors often use imaging tests, such as echocardiograms, to check valve performance. Patients with mechanical valves must take blood-thinning medicine for life to lower the risk of blood clots. Biological valves do not require these medications but often wear out and might need replacement in the future.
Mechanical valves generally last longer and rarely wear out, but can pose different risks. Valves can sometimes develop problems such as leaking or reduced function. If this happens, doctors may recommend another surgery or a catheter-based procedure. Typical ongoing recommendations include:
- Follow-up visits for status checks.
- Imaging tests to verify valve function.
- Medications, such as anticoagulants for mechanical valves.
- Lifestyle changes in these areas:
| Focus Area | Example Actions |
|---|---|
| Diet | Choose heart-healthy foods |
| Exercise | Get regular activity |
| Stress | Practice stress reduction |
| Tobacco | Avoid smoking and tobacco |
Healthcare providers often suggest cardiac rehabilitation programs. These programs help patients rebuild strength, learn about healthy choices, and safely return to everyday life.
