Establish heart-lung bypass
When your heart is visible, the surgeon will place you on a
heart-lung machine, which will take over the function of your heart and lungs
for the remainder of the operation by circulating oxygen-rich blood throughout
your body. To attach you to the heart-lung machine, the surgeon will insert a
tube into your right atrium, which receives oxygen-depleted blood from your
body. Instead of going to your lungs to receive oxygen, the blood travels to
the heart-lung machine to exchange carbon dioxide for oxygen. The blood then
travels through a tube back to your aorta, which supplies blood to your entire
During bypass, your aorta is clamped near your valve to prevent
blood from interfering with the surgery. To stop your heart temporarily, the
surgeon will flush it with cold salt water or with a medicine. The surgeon
will then bathe the heart in a solution that allows it to survive being
deprived of blood for a short time.
This bypass is needed because it is difficult to work on your
heart while it is beating. The bypass allows the surgeon to stop your heart
temporarily without interfering with the circulation of oxygen-rich blood to
your body. Bypass also reduces the risk of serious bleeding
Remove the old valve
After blood flow is diverted to the heart-lung machine, the surgeon
will make an incision in the aorta to expose the aortic valve. The surgeon will
inspect the aorta and the valve to evaluate the extent of disease. If only your
valve is diseased, the surgeon will cut out the valve leaflets. If the aorta is
also diseased, the surgeon may also cut out a portion of the aorta and replace
it with a graft, which may be part of the replacement valve.
Attach the new valve
After the old valve is removed, the surgeon will use a device to
measure the size of the valve opening to select the proper size for the
replacement valve. In general, the surgeon will choose the largest possible
valve to ensure the best possible blood flow through the valve. The surgeon may
then place the valve in the opening to make sure it fits correctly. After
properly aligning the valve, the surgeon will sew it in place.
The surgeon will then check the placement to make sure there is no
room for leaks. The stitches are then tied off and trimmed.
Remove heart-lung bypass
When the new valve is in place, the surgeon will allow some blood
to flow through the valve to check for leaks. The surgeon will sew up the
aorta, remove air bubbles from your heart, and restore blood flow. When blood
flows through your heart, it will typically start beating again. Sometimes,
though, the heart begins to beat erratically (fibrillate), and the surgeon
will give it an electrical shock to induce normal beating patterns.