What Is Aortic Valve Replacement Surgery?

You might need this operation if you have a problem with your heart’s aortic valve.

When this valve opens, blood goes from your heart into your aorta (the largest artery in your body) and on to the rest of your body. When your aortic valve closes, it keeps blood from flowing the wrong way back into your heart. This cycle repeats with every heartbeat.

If certain things go wrong with that valve, your doctor may recommend that you have surgery to replace it.

Aortic Valve Problems

You might have trouble with your aortic valve because of a problem you were born with. Or, it could be from wear and tear over the years, or because of another health condition, like a heart infection.

Any of these issues can lead to:

Regurgitation, when the valve doesn’t close all the way and blood flows backward into the heart

Stenosis, when the opening of the valve gets too narrow and not enough blood flows out

Those problems can cause shortness of breath, chest pain, dizziness, fainting, and other symptoms. If you don’t get the valve replaced, it can be life-threatening.

Replacement Aortic Valves

There are two main types.

Mechanical valves are carbon, metal, or plastic. They last long but boost your chances of having blood clots. You’ll have to take drugs called blood thinners for the rest of your life. Your doctor will check your med levels often because too little won’t help with clots, but too much could cause heavy bleeding, especially after an injury.

Biological valves come from animal tissue. They last 10-20 years. That’s not as long as mechanical valves, but they don’t lead to clots and you won’t need blood thinners.

You and your doctor should talk about the pros and cons of each type, and what’s best for you.

What Happens

The most common procedure is open-heart surgery, which usually takes 2-4 hours.

First, you’ll get medicines so you’ll be “asleep” for the operation. Then, your doctor:

  • Makes a 6- to 8-inch opening in your chest
  • Splits open your breastbone
  • Stops your heart and hooks you up to a heart-lung machine, which takes over pumping your blood
  • Takes out the damaged valve and puts in a new one
  • Restarts your heart and closes up your chest

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In some cases, you may be able to get “minimally invasive” surgery instead. You get a smaller cut in your chest, and your breastbone won’t be opened all the way, if at all.

With one type of operation, called transcatheter aortic valve replacement (TAVR), you get a thin tube that runs through a small opening in your leg and up to your heart. Your doctor uses that tube to put in the new valve.

While it usually means a shorter hospital stay, less pain, and maybe a faster recovery, minimally invasive surgery won’t work for everyone. It’s usually recommended for people if open-heart surgery is too risky. Your doctor will recommend the operation that’s best for you.

Preparing for the Operation

To make sure you’re healthy enough for surgery, you’ll get:

Tell your doctor about any medicines or supplements you take, including:

  • Vitamins
  • Herbal or natural medicines
  • Drugs you buy “over the counter” (meaning that they don’t need a prescription)
  • Prescription medicines

You may need to stop taking certain ones before surgery.

Also tell your doctor about any illnesses you have, even a simple cold. It might seem minor, but it could affect your recovery.

If you smoke, you’ll need to stop 2 weeks before surgery to help prevent blood clots and problems breathing.

The night before surgery, you’ll likely need to wash with a special soap that your doctor provides to kill germs. And in most cases, you won’t be allowed to eat or drink anything after midnight.

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Recovery: What to Expect

Things that can affect your surgery include your age, overall health, and the type of surgery. You’ll likely spend about a week in the hospital.

When you first get home, your wound will might be sore, swollen, and red. You’ll get tired easily. You might not feel like eating much, and you might find it hard to sleep. That’s all to be expected, and it gets better with time.

Your breastbone will take 6-8 weeks to heal, but it might be 3 months or so before you feel back to normal. Your doctor may suggest an exercise program or cardiac rehab to help.

As far as getting back to work, expect it to take 6-8 weeks for a desk job. If your work is more physical, it could take up to 3 months.

What Are the Risks?

Most people do well with this surgery. Like any operation, though, it can lead to problems, including:

  • Bleeding after surgery
  • Blood clots
  • Heart rhythm gets thrown off for a while
  • Infection
  • Kidney problems that may last for a few days after surgery
  • New valve doesn’t work or wears out over time
  • Stroke

Call your doctor if you notice any of these signs during your recovery:

  • Fever of 100.4 F or higher
  • Pain, redness, or swelling around the wound gets worse
  • Pus or other fluid coming from the wound
  • Shortness of breath that gets worse
  • Symptoms you had before surgery, like chest pain or dizziness, come back

WebMD Medical Reference Reviewed by Suzanne R. Steinbaum, MD on October 16, 2017

Sources

SOURCES:

The Society of Thoracic Surgeons: “Aortic Valve Disease.”

Cleveland Clinic: “Aortic Valve Surgery.”

Texas Heart Institute: “Valve Repair or Replacement.”

National Health Service: “Aortic Valve Replacement.”

American Heart Association: “Types of Replacement Heart Valves.”

Mayo Clinic: “Aortic valve repair and aortic valve replacement.”

Johns Hopkins: “Aortic Valve Replacement: Minimally Invasive.”

European Society of Cardiology: "Transcatheter aortic valve implementation: indications."

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