Aortic Valve Surgery

What is aortic valve surgery?

Aortic valve surgery is a treatment for aortic valve disease. It involves repairing or replacing your aortic valve. This “door” manages blood flow from your heart’s main pumping chamber (left ventricle) into your main artery (aorta). Your aorta sends oxygen-rich blood to your entire body, so it’s important that your aortic valve works well.

Aortic valve disease prevents your aortic valve from functioning as it should. Your valve opening may be too narrow, which limits how much blood can flow through. Or your valve may be leaky, which means some blood flows backward each time your valve closes. Some people are born with congenital heart conditions that may affect valve function.

Cardiac surgeons perform aortic valve surgery to treat:

• Aortic valve regurgitation (leaky valve)
• Aortic valve stenosis (narrowed valve opening)

Although the thought of aortic valve surgery may be overwhelming, an operation can address the valve issue you have. It can also lower your risk of complications of valve disease, like heart failure and cardiac arrest. Thousands of people have had successful aortic valve surgery.

How serious is aortic valve surgery?

Since aortic valve surgery takes multiple weeks of recovery afterward, it falls into the “serious” category. It also qualifies as “serious” because of the important role your aortic valve plays in getting oxygen-rich blood to your body.

Types of aortic valve surgery

There are two main types of aortic valve surgery:

• Aortic valve repair. Your surgeon fixes damaged parts of your valve while keeping as much of the natural tissue as possible.
• Surgical aortic valve replacement (SAVR). Your surgeon removes your damaged valve and puts a new one in its place. SAVR is an option for some people who aren’t candidates for transcatheter aortic valve replacement (TAVR/TAVI). Instead of working through an incision in your chest, surgeons use a catheter that goes through your blood vessels for TAVR.

Many factors determine the type of surgery you need, including:

• The results of your diagnostic tests
• Your age
• The structure of your heart
• The presence of other medical conditions

Your surgeon will talk to you about your options and explain the most appropriate treatment plan for you. If you’re getting a heart valve replacement, you may receive a valve made of animal or human tissue. Another option is a mechanical valve. Each type has its pros and cons, so be sure to discuss these with your surgeon.

How should I prepare for aortic heart valve surgery?

In addition to giving you a physical exam, your healthcare provider may order tests before your surgery. Possible tests include:

• Cardiac catheterization (heart cath)
• Chest X-ray
• Computed tomography (CT) scan
• Echocardiogram (echo)
• Electrocardiogram (EKG)
• Lab tests, including blood tests and urine tests

Your provider will give you instructions that you should follow closely. These instructions will tell you:

• When you should begin fasting (stop eating and drinking), which is usually after midnight the night before your surgery
• Whether you should make any changes to your medication schedule
• When to arrive at the hospital

Ask your provider if anything is unclear. It’s important to understand exactly what you need to do before your surgery.

What happens during aortic valve surgery?

To perform aortic valve surgery, your surgeon and care team will:

1. Give you anesthesia so you’ll be asleep and pain-free during the surgery
2. Make one or more cuts in your skin (incisions) to access your heart
3. Connect you to a heart-lung machine
4. Stop your heart so your surgeon can work on it
5. Repair or replace your aortic valve
6. Restart your heart
7. Disconnect you from the heart and lung machine
8. Close your incision(s)
9. Move you to a recovery area

The exact details of your surgery depend on the surgical approach.

Approaches to aortic valve surgery

Approaches to aortic valve replacement or repair surgery include:

• Traditional open-heart surgery. Your surgeon makes a 6- to 8-inch incision down the center of your chest to access your heart.
• Minimally invasive heart surgery. Your surgeon uses smaller, 2- to 4-inch incisions without opening your whole chest. This typically involves a “J” incision. This approach reduces blood loss, trauma and length of hospital stay. You may also have a faster recovery.

The most suitable method for you depends on many factors, including:

• The nature of your valve disease (for example, how complex it is)
• Other heart problems that require treatment
• Your overall health
• Considerations based on the anatomy of your chest

Your surgeon will talk to you about the approach that’s best for you, and why.

How long does it take?

Aortic valve surgery takes at least two hours. The length of time varies by the type of surgery you have.

What happens after aortic valve surgery?

Here’s what you can expect after your surgery:

• You’ll recover in the intensive care unit (ICU) and then a regular hospital room. The total hospital stay after heart valve surgery is typically five to seven days.
• Your care team will monitor your vital signs and encourage you to start moving around a little more each day.
• Your provider may recommend cardiac rehab to help you continue your recovery and regain your strength.

What are the benefits of aortic valve surgery?

Aortic valve surgery is lifesaving. It fixes problems with your heart valve that, over time, could be fatal without treatment. Aortic valve disease is the deadliest form of valve disease. It accounts for more than 60% of all deaths from any type of valve disease.

So, surgery to repair or replace your aortic valve can help you live longer. It can also relieve symptoms so you feel better day to day.

What is the success rate of aortic valve surgery?

Transcatheter aortic valve replacement (TAVR) has a 92% success rate. For aortic valve repair, multiple studies have reported high survival rates without the need for a second operation for most people.

What are the risks or complications?

Like all surgeries, aortic valve surgery has some risks. Possible complications include:

• Allergic reaction to anesthesia
• Bleeding
• Heart attack
• Heart failure
• Infection in your wound, heart valve, bladder or lung
• Blood clots
• Stroke
• Abnormal heart rhythm (arrhythmia), which is usually temporary
• Kidneys not working as well as usual, which is temporary

Risks are higher for some people compared to others. Factors that influence your risk for complications include:

• Your age
• Your medical conditions
• The method of surgery (open vs. minimally invasive)

Talk to your healthcare provider about your level of risk and how to lower it.

Can you repair an aortic valve without surgery?

Nonsurgical treatments like medications may help manage your aortic valve disease for a long time. But you may need surgery if you have symptoms, evidence of heart damage or heart failure. That doesn’t mean you need open-heart surgery, though. You may be a candidate for a type of aortic valve replacement your surgeon can do without opening your chest.

What is the recovery time?

Recovery from aortic heart valve surgery generally takes four to eight weeks. It may be shorter if you have minimally invasive surgery.

You can expect to feel tired for a few weeks after your surgery. That’s normal, and it’s important not to push yourself. Still, it’s also important to follow your healthcare provider’s guidance for exercise, including cardiac rehab. A gradual, safe return to movement will support your recovery and long-term health. Your provider will tell you when it’s safe to drive or lift heavy objects.

Remember that each person’s recovery is unique. Try not to compare your recovery or how you’re feeling to others who’ve had heart surgery. If you need more time to feel normal again, that’s OK. Give your body the time it needs to rest and heal.

You can expect to have a follow-up appointment with a healthcare provider during the first week after your surgery. You’ll have another visit about six weeks after surgery. After that, you’ll return as often as your provider recommends.

Some people experience depression after heart surgery. This is common and treatable. Talk to your healthcare provider or a counselor if you have symptoms of depression. These may include feeling very sad or hopeless or losing interest in your usual activities.

When can I go back to work?

You can return to work in about six to 12 weeks. This can vary depending on the type of surgery you have and the type of work you do. If you have a job that’s physically demanding, you’ll need more time to recover.

When should I call my healthcare provider?

Call your healthcare provider if you have signs of complications, like:

• Chest pain or pressure
• Drainage or pus around your incision site
• Fever or chills
• Heart palpitations
• Pain near your incision
• Swelling or redness around your incision site
• Swelling (edema) in your legs or feet
• Weight gain of more than 3 pounds in one week