In aortic valve replacement surgery, your aortic valve is replaced with a different valve—mechanical or tissue. This procedure may be necessary if you have a valve defect or disease or another heart or vascular condition. The purpose of the procedure is to improve blood flow through your heart, improving symptoms such as chest pain and shortness of breath. Isolated aortic valve replacement is usually performed with minimally invasive surgery and techniques.
Aortic valve repair, though less common, may be possible. Aortic valve repair is a difficult procedure and should be performed only by very experienced surgeons.
Ohio State's Wexner Medical Center offers a team approach to heart valve surgery, which means each patient is evaluated by a cardiologist, a cardiac surgeon, a cardiac sonographer, interventional cardiologist and an anesthesiologist. This integrated approach means that each patient’s heart valve disease is treated individually, with that particular patient’s needs – and physical condition – in mind. In addition, we offer minimally invasive surgery, which results in smaller incisions, reduced hospital stays and shorter recovery times. Open heart surgery is also available if that is determined to be the best treatment option.
What Is Aortic Valve Replacement?
Aortic valve replacement involves removing your aortic valve and replacing it with a mechanical valve or a tissue valve drawn from an animal or human cadaver. Mechanical valves are made of metal or plastic; a risk associated with metal replacement valves is formation of blood clots around the valve. If you have a mechanical valve replacement, you will need to take anticoagulant medication for the rest of your life to prevent blood clots. A risk associated with tissue replacement valves is that they may need to be replaced.
Why Have an Aortic Valve Replacement?
When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Conditions that may require you to have valve replacement include valve stenosis and regurgitation.
You may be a candidate for a cardiac catheterization procedure (percutaneous aortic valve replacement or PAVR) in which the valve is replaced using a catheter, without open-heart surgery.
What to Expect During Aortic Valve Replacement
Preparing for Your Procedure
Prior to your aortic valve replacement, you’ll meet with your physician to discuss your medical history, medications you take and any questions you have. Tests you may have before heart valve surgery include:
- Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine.
- Blood tests– Studies to detect enzymes that leak into the blood when the heart has been damaged and to detect infection and antibodies.
- Urine tests
- Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
- Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
- CT angiogram (CTA - computed tomography angiogram) – An imaging procedure that uses CT technology to produce cross-sectional, detailed images of blood vessels.
- Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
If you use tobacco, you will be instructed to quit at least two weeks before surgery. Tobacco use can interfere with the blood’s ability to clot properly. Your physician can prescribe a nicotine-replacement product to help you stop tobacco use. You may want to visit your dentist prior to surgery to ensure there are no infected teeth in your mouth.
As in the case of most surgeries, your physician will ask you to not eat or drink a certain number of hours beforehand, often nothing after midnight the night before.
The area where your incision will be made is shaved and cleaned prior to surgery to reduce risk of infection. You will be given anesthetic medication to put you “to sleep” during surgery.
During Your Procedure
You are connected to monitoring equipment (electrocardiogram) to check your heart’s activity during the procedure. You also have an intravenous line in your arm to provide anesthesia throughout the procedure. A mechanical respirator breathes for you during the surgery, via a tube inserted in your windpipe. Another tube, inserted in your nose and through your throat, prevents air and liquid from pooling in your stomach. Still another tube, a catheter, is inserted into your bladder.
Heart valve surgeries require the use of a heart-lung machine. This keeps blood flowing during the procedure. The machine takes over this function for your body, and your body takes over again when the procedure is completed.
The surgeon makes an incision in your chest to access your valve. The replacement is made, your heart is restarted, and the heart-lung machine is disconnected. Traditional valve surgery takes several hours.
If you have minimally invasive surgery, the incision is much smaller and the hospital stay and recovery time are shorter.
After Your Procedure
If you have traditional heart valve surgery, you may remain in the hospital for as long as a week or two.
Your medical team will help you get up and about one or two days after surgery. You may feel stiff and sore, but it is important to breathe deeply and cough to clear fluids from your lungs. You will be allowed to eat normally in most cases.
After your surgery, you may need to take medication to prevent blood clots from forming on the new valve. You also may hear a mechanical valve clicking in your chest. This is normal.
If your job involves primarily sitting at a desk, you usually can return to work in four to six weeks.