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 properly, 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 disease treatment depends on the severity of your condition, whether or not you’re experiencing signs and symptoms, and if your condition 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 normal, one-way direction from the ventricle to the aorta.
Back flow may be caused by a dysfunctional or leaky valve. 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 pump 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 result in other problems that prevent the aortic valve from working properly. 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.
But 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 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 individual 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 individual 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 normally performed through traditional open-heart surgery, so your aortic valve procedure would be performed the same way.
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 performs high volumes of aortic valve surgeries.
Risks associated with aortic valve repair and aortic valve replacement surgery may include:
Valve dysfunction in replacement valves
Heart rhythm problems
What is the success rate of heart valve replacement surgery?
When a person’s aortic stenosis becomes severe, the average survival rate without surgical intervention is only 50 percent after two years and only 20 percent after five years. Evidence is also clear that with proper treatment, most people enjoy a return to good health and add many years to their life.
How long do you stay in the hospital after a heart valve replacement?
You can expect to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU). Recovery after valve surgery may take a long time, depending on how healthy you were before the operation.
What can I expect after heart valve replacement?
The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles.
Can a heart valve be replaced without open heart surgery?
Replacing an aortic valve without open-heart surgery. … Until recently, open-heart surgery was the only option for replacing the valve. But a treatment called transcatheter aortic valve replacement, or TAVR offers a less invasive alternative with an easier, shorter recovery.
How long does it take for your chest to heal after open heart surgery?
Beyond six weeks of recovery. If the surgeon divided your breastbone during your surgery, it will be about 80 percent healed after six to eight weeks. By that time, you generally are strong enough to get back to normal activities such as driving.