Aortic Valve Replacement Surgery 

A heart valve functions to prevent the backflow of blood to its chambers as the heart pumps to move blood forward to the circulation. As the heart pumps blood from your left ventricle out to the large artery called aorta, the aortic valve, which guards the opening between them, opens and closes to prevent blood from leaking back into the ventricle.

There are four valves in heart including mitral valve, tricuspid valve, aortic valve and pulmonary valve. See the location of the aortic valve:

 

An aortic valve replacement surgery involves the removal of the damaged aortic valve, followed by its replacement with an artificial valve to restore normal heart function.

When Is Aortic Valve Replacement Surgery Needed?

An aortic valve replacement surgery is needed in two instances:

1. Aortic Stenosis

Aortic stenosis occurs when the heart's valve becomes narrowed, thus obstructing blood flow from the heart into the aorta, and preventing the onward flow of blood to the rest of the body. Aortic stenosis makes the heart work harder, which eventually leads to weakness of the heart muscle. When left untreated, severe valve stenosis can lead to serious heart disease, so aortic valve replacement is necessary.

2. Aortic Regurgitation

Aortic regurgitation occurs when the valve does not close tightly after blood is pumped from the heart to the aorta. This allows some blood to leak back into the ventricle, thus preventing the heart from pumping blood efficiently to the rest of the body. This results in fatigue and shortness of breath. This condition may occur suddenly or it may develop over many years. Severe aortic regurgitation requires surgery to repair or replace the defective aortic valve.

How Is Aortic Valve Replacement Surgery Carried Out?

Aortic valve surgery may be done either through a minimally invasive surgery or through an open-heart surgery. The option of choosing to have minimally invasive surgery instead of open-heart surgery will depend on whether the doctor recommends it. If patients also need to have coronary artery bypass surgery, minimally invasive surgery may not be an option.

There are many differences between the two surgeries:

Aortic Valve Replacement Surgery
  Minimally Invasive Surgery Open-Heart Surgery
Description
  • Small incisions are made in the chest
  • Endoscopy or thoracoscopy, percutaneous surgery and robot-assisted surgery are the different techniques to do the surgery
  • Surgery may take 3 to 6 hours
 
  • A large incision on the chest is made (sternotomy)
  • Aside from the surgery, other procedures may be done, including a coronary bypass surgery, if needed
  • Surgery may take 2 to 5 hours
Possible Risks
  • Damage to nearby organs, nerves, blood vessels and bone
  • Infection
  • Heart attack or stroke
  • Kidney failure
  • Irregular heartbeat, which may need treatment with a pacemaker or drugs
  • Poor healing of skin incision
  • Heart attack or stroke
  • Problems in heart rhythm
  • Increased risk of incision infection
  • Infection involving the new aortic valve
  • Kidney failure
  • Memory loss, loss of mental clarity
  • Poor healing of skin incision
  • Persistent low-grade fever and chest pain (postpericardiotomy syndrome), which may last up to 6 months

Benefits of Minimally Invasive Surgery Over Open-Heart Surgery:

  • Blood loss is minimal
  • Less need for blood transfusion
  • Irregularities in heartbeat are less likely during surgery
  • Removal of breathing tube after surgery may be done sooner
  • Less pain is experienced during recovery period
  • Hospital stay is shorter
  • Smaller incision scar
  • Risk of infection is lower
  • Infection, if it occurs, is easier to treat

Types of New Valves

During an aortic valve replacement surgery, the damaged valve will be replaced with a new one. Two types of new valves include:

  • A mechanical valve that is made of synthetic materials, such as carbon or titanium, which is longer lasting. However, patients will need to take warfarin or aspirin (blood-thinning medicines), for the rest of their lives if they get this type of valve.
  • A biological valve, which is from animal or human tissue. This type of valve lasts for 10 to 20 years, but patients may not need to take blood-thinning drugs for life.

Recovering From Aortic Valve Replacement Surgery

Patients are taken to the ICU (intensive care unit) after an aortic valve replacement surgery, where they are closely monitored for 24 to 48 hours.

1. Ventilator

An artificial breathing machine called a ventilator that helps move oxygenated air in and out of the lungs is attached through an endotracheal tube, into the mouth or nose. Patients wake up from surgery with the tube still in place, which may make them feel uncomfortable. They will not be able to eat, drink or talk. Once the patient is able to breathe on his own, the tube and the ventilator are removed and a mask is placed over the mouth and nose to resume oxygen supply.

2. Pain Management

Some pain or discomfort may be expected after an aortic valve replacement surgery, as in other types of surgery. Patients are given painkillers after the anesthetic wears off. These may be continued at home, but pain and discomfort are likely to get better as the incision wounds heal.

3. Moving to a Ward

Patients are transferred from the ICU to the surgical ward when the doctors think they are ready. However, some patients may be moved to a high dependency unit if they need to be kept under close observation after the operation.

Tubes and monitors may be attached to the patients, including:

  • Chest drains, which are small tubes that drain the build-up of blood or fluids from the chest
  • Pacing wires, if your heart rate needs to be controlled (to be removed after four to five days)
  • Monitoring wires with sensor pads, which measure heart rate, blood pressure, blood flow, and air flow to the lungs
  • An urinary catheter or a tube inserted into the bladder, where urine can pass

A care team in the ward helps the patients get back on his diet and encourages them to get up as soon as possible. Depending on their progress, patients may be able to go home 7 to 10 days after the operation. Cardiac rehabilitation and physiotherapy are discussed before patients go home to help them quickly recover and prevent further heart problems.

4. Recovery Time

Recovery time after surgery depends on the patient’s age, overall health, and preoperative condition. Healing of the breastbone usually takes about 6 to 8 weeks, and it may take 2 to 3 months before patients feel completely well.

5. Going Home

Patients are advised to take things slowly at home until they fully recover. Some symptoms that may be normally experienced after leaving the hospital include:

  • Decreased appetite, due to decreased sense of taste
  • Redness and swelling of the incision site, which will gradually improve
  • Trouble sleeping, which usually improves with time
  • Constipation, which may improve by drinking plenty of fluids and eating fruits and vegetables. A laxative may be needed to help pass stools easily
  • Anxiety and depression, which are common after heart surgery. Support from friends and family usually help patients feel emotionally stronger as they regain their health

6. Caring for Your Wound

  • ┬čIf the surgeons used dissolvable stitches to close the wound, the wounds will disappear within 3 weeks. However, doctors may need to remove other stitch types during a follow-up appointment.
  • When taking a bath, wash the wound using water and mild soap. Avoid using very hot water or soaking in the bath until the incision wound is healed.
  • ┬čAvoid exposing the wound to sunlight during the first year after the surgery, because the scar may become darker if exposed to the sun.

When to See a Doctor

Call your doctor if you experience signs of infection such as:

  • Tenderness in the incision site
  • Increasing swelling or redness
  • Pus
  • High fever

The video below will help you know more about aortic valve replacement surgery: