At UVA Health, our heart care services received the highest possible rating from U.S. News & World Report. They've also named 4 of our cardiovascular treatments and procedures as "high performing," including aortic valve surgery.
Aortic valve replacement is an open-heart surgery that replaces a malfunctioning aortic valve with a new one. The amount of oxygen-rich blood getting out to the body can be significantly decreased with a faulty valve. The replacement valve may be:
- Mechanical — Made entirely out of artificial materials.
- Bioprosthetic — Made out of a combination of artificial materials and tissues from a pig, cow or other animal.
- Homograft or allograft — Harvested from a donated human heart.
- Ross procedure (self-donated) — In selected patients younger than 50 years of age, another one of the patient’s own heart valves may be removed from its original location and sewn in to take the place of the faulty aortic valve. A homograft is then sewn in to take the original place of the pulmonic valve.
- Transcatheter Aortic Valve Implantation (TAVI) — A bioprosthetic valve is implanted from a catheter-based delivery system via a small incision in either the groin or the side of the chest.
Aortic Valve Surgery: What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Blood tests
- Echocardiogram
- Electrocardiogram
- Cardiac catheterization
You may be asked to stop taking some medicines up to one week before the procedure, like aspirin or other anti-inflammatory drugs and blood thinners.
Description of Transcatheter Aortic Valve Implantation
During transcatheter aortic valve replacement, a small incision is made in either your groin or the side of your chest. Your heart will continue to beat on its own. Your doctor inserts the new valve using a catheter with a balloon on the end and threads it into position. The old valve is pushed aside by the new valve. The incision in the groin or the side of the chest is then sewn back together.
Aortic valve replacement is done with general anesthesia.
Description of Open Aortic Valve Replacement
An incision is made down the middle of your chest and your breastbone is separated to reach your heart. A heart-lung machine acts as your heart and lungs, which allows your doctor to stop your heart and safely work on the heart valve.
An incision is made in the aorta, and the damaged valve is removed while a new valve is sewn into place. The aorta is then be sewn back together, and your heart is started up again to remove the heart-lung machine. Your breastbone is wired together, and the chest incision is sewn back together.
The entire procedure should take about 2-4 hours.
After the Procedure
In the ICU, healthcare providers will monitor you while you're connected to a number of devices, including:
- Monitors to track your heart rate, breathing rate, blood pressure and the percentage of oxygen in your bloodstream
- A ventilator tube in your mouth and lungs to breathe for you or an oxygen mask or tube to give you extra oxygen
- Tubes to drain extra fluid from your chest
- A tube that goes into your nose and down to your stomach to drain your stomach of excess fluid and gas
- A catheter in your bladder to drain urine
- An IV line to provide fluids, electrolytes, and pain medicines directly into a vein
A usual hospital stay is 5-7 days, depending on your overall health and your recovery progress.
Postoperative Care
At the Hospital
You'll be in the ICU for 1-2 days before moving to a regular hospital room, where you will stay for several more days. You can walk soon after surgery.
You may be asked to use an incentive spirometer device every couple of hours to help keep your lungs as open as possible and avoid pneumonia.
At Home
Expect to resume your normal activities within about six weeks of surgery. Follow your doctor’s directions about when you can begin to drive, exercise, lift things and otherwise exert yourself.
- If you have a mechanical valve, you will have to take blood-thinning medicines for the rest of your life to keep clots from forming around the valve.
- You may need to take antibiotics before you have dental procedures or certain surgical procedures.
Contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding or any discharge from the incision site
- Shortness of breath, lightheadedness or fainting
- Cough or chest pain
- Nausea and/or vomiting that you cannot control
- Difficulty urinating or pain, burning, frequency, urgency or bleeding with urination
- Pain or swelling in your feet, calves or legs
Reasons for Aortic Valve Replacement
Sometimes, the aortic valve is misshapen due to a birth defect, known as congenital aortic valve disease. Other times, the aortic valve works well for years before becoming too stiff or too floppy to open and close fully, called acquired aortic valve disease.
Normal aging can also cause calcium build-up on the valve, which results in a malfunction. Other causes include:
- Rheumatic valve disease — a complication of streptococcal throat infection, which can damage the valve
- Endocarditis — an infection inside the heart that involves the valves
- Aortic aneurysms — an abnormal widening or outpouching of the aorta
- Aortic dissection — bleeding into the wall of the aorta, usually due to the presence of an aortic aneurysm
Risks With Aortic Valve Replacement
Possible complications may include:
- Infection
- Bleeding
- Irregular heart beats
- Scarring
- Blood clot formation resulting in a stroke or kidney damage
- Valve does not function correctly
- Complications from anesthesia
Some factors that may increase the risk of complications include:
- Other heart conditions
- Lung conditions
- Chronic illness, including high blood pressure and diabetes
- Increased age
- Infections
- Smoking
- Obesity
Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.