Valve Replacement & Repair Surgery

Aortic valve repair and aortic valve replacement are procedures that treat diseases affecting the aortic valve.

The aortic valve is one of four valves that regulate blood flow through the heart. These valves keep blood flowing in the correct direction through the heart.

The aortic valve separates the heart's main pumping chamber (left ventricle) and the main artery that supplies oxygen-rich blood to your body (aorta).
With each contraction of the ventricle, the aortic valve opens and allows blood to flow from the left ventricle into the aorta. When the ventricle relaxes, the aortic valve closes to prevent blood from flowing backward into the ventricle.

When the aortic valve isn't working correctly, it can interfere with blood flow as well as force the heart to work harder to supply the necessary blood to the rest of your body.

In some people, aortic valve disease may not cause any signs or symptoms for many years, if at all. Others may experience shortness of breath, fatigue, chest pain, loss of consciousness, irregular heartbeat (arrhythmia), heart failure, and sudden cardiac death.

Aortic valve repair or aortic valve replacement can treat aortic valve disease and help restore normal blood flow, reduce symptoms, prolong life, and help preserve the function of your heart muscle.

Why it's done:

  • Aortic valve regurgitation
  • Aortic valve stenosis
  • Aortic valve stenosis

Aortic valve disease treatment depends on the severity of your condition, whether or not you're experiencing signs and symptoms, and if your state is getting worse.

Types of aortic valve disease that may require treatment with aortic valve repair or replacement include:

  • Aortic valve regurgitation occurs when blood flows backward through the aortic valve into the left ventricle each time the ventricle relaxes rather than in the average, one-way direction from the ventricle to the aorta.
  • A dysfunctional or leaky valve may cause backflow. This may be due to deterioration of the valve, an abnormal valve shape present at birth (congenital heart disease) or by a bacterial infection.
  • Aortic valve stenosis causes the aortic valve to become narrowed or obstructed, which makes it harder for the heart pumps blood into the aorta. This may be caused by congenital heart disease, thickening of the valve's closure flaps (cusps) or post-inflammatory changes, such as those associated with rheumatic heart disease.
  • Congenital heart disease may contribute to aortic valve regurgitation or stenosis as well as a result of other problems that prevent the aortic valve from working correctly. For example, a person may be born with an aortic valve that doesn't have enough tissue flaps (cusps), the valve may be the wrong size or shape, or there may not be an opening to allow blood to flow normally (atresia).

For some people with mild aortic valve disease without symptoms, careful monitoring under a doctor's supervision may be all that's needed.

However, in most cases, aortic valve disease and dysfunction progress and get worse despite medical treatment. Most aortic valve conditions are mechanical problems that cannot be adequately treated with medication alone and will eventually require surgery to reduce symptoms and the risk of complications, such as heart failure, heart attack, stroke or death due to sudden cardiac arrest.

Aortic valve repair or replacement?

The decision to repair or replace a damaged aortic valve depends on many factors, including:

  • The severity of your aortic valve disease
  • Your age and overall health
  • Whether you need heart surgery to correct another heart problem in addition to aortic valve disease, such as heart bypass surgery to treat coronary artery disease so that both conditions can be treated at once.

In general, heart valve repair is usually the first choice because it's associated with a lower risk of infection, preserves valve strength and function, and reduces the need to take blood-thinning medications for the rest of your life as necessary with certain types of valve replacement. For example, people with a hole in the valve's closure flaps (perforated valve leaflet) may be candidates for aortic valve repair rather than replacement, depending on the severity of their condition.

Not all valves can be repaired, however, and heart valve repair surgery is often harder to do than valve replacement. Your best option will depend on your situation as well as the expertise and experience of your multidisciplinary heart team.

Aortic valve repair and aortic valve replacement may be performed through traditional open-heart surgery, which involves a cut (incision) in the chest, or through minimally invasive methods that involve smaller incisions in the chest or a catheter inserted in the leg or chest (transcatheter aortic valve replacement, or TAVR).

Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery, and less pain than traditional open-heart surgery. Minimally invasive heart surgery should generally be performed by a multidisciplinary heart team experienced in these types of procedures.

What type of procedure you have depends on your situation, and your doctor will explain the benefits and risks of each option.For example, some people with aortic valve disease may not be candidates for traditional open-heart surgery due to other health problems, such as lung or kidney disease, that would make the procedure too risky.

Many people with aortic valve disease also have coronary artery disease and may need heart bypass surgery to improve blood flow. Heart bypass surgery is usually performed through traditional open-heart surgery, so your aortic valve procedure would be delivered the same way.

Risks

Aortic valve repair and aortic valve replacement surgery risks vary depending on your health, the type of procedure, and the expertise of your health care team. To minimize potential risk, aortic valve surgery should generally be performed at a center with a multidisciplinary heart team experienced in these procedures, and that delivers high volumes of aortic valve surgeries.

Risks associated with aortic valve repair and aortic valve replacement surgery may include:

  • Bleeding
  • Blood clots
  • Valve dysfunction in replacement valves
  • Heart rhythm problems
  • Infection
  • Stroke
  • Death

What you can expect

During the procedure

For most aortic valve repair and aortic valve replacement procedures, you'll receive anesthetics so you won't feel any pain, and you'll be unconscious during the surgery.

You'll also be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

Aortic valve repair

Aortic valve repair is usually performed through traditional open-heart surgery and opening of the chest bone (sternotomy). Doctors wire the bone back together after the procedure to prevent movement and aid in healing.
Aortic valve repair procedures may involve several different types of repair, including:

  • Inserting tissue to patch holes or tears in the flaps (perforated cusps) that close off the valve
  • Adding support at the base or roots of the valve
  • Separating fused valve cusps
  • Reshaping or removing tissue to allow the valve to close more tightly
  • Tightening or reinforcing the ring around a valve (annulus) by implanting an artificial ring (annuloplasty)

Aortic valves that can't open fully due to aortic valve stenosis may be repaired with surgery or with a less invasive procedure called balloon valvuloplasty — which uses an approach called cardiac catheterization. You're usually awake during cardiac catheterization, and it requires a much shorter hospital stay than traditional heart surgery.

Balloon valvuloplasty is often used to treat infants and children with aortic valve stenosis. However, the valve tends to narrow again in adults who have had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement. You may need additional procedures to treat the narrowed valve over time.

Doctors may also use a catheter procedure to perform aortic valve repair by inserting a plug or device to fix a leaking replacement heart valve.

After the procedure

You'll generally spend a day or more in the intensive care unit (ICU). You'll be given oxygen, fluids, nutrition, and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your chest.

After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure.

During your hospital stay, your treatment team will likely:

  • Watch for signs of infection in your incision sites
  • Periodically check your blood pressure, breathing and heart rate
  • Work with you to manage any pain you experience after surgery
  • Instruct you to walk regularly to gradually increase your activity and do breathing exercises as you recover

Your doctor may give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.

Recovery time depends on your procedure, overall health before the procedure and any complications.

Your doctor may advise you to avoid driving a car or lifting anything more than 10 pounds for several weeks. Your doctor will discuss with you when you can return to normal activities.