Aortic Valve Repair

What is aortic valve repair?

Aortic valve repair is a type of heart valve surgery that helps the “door” between your heart and your body’s main artery (aorta) work normally. This “door” (your aortic valve) opens and closes with every heartbeat to manage blood flow from your heart’s lower left chamber into your aorta. Damage to your valve can prevent it from opening and closing how it should.

For example, some people develop a leaky aortic valve (aortic regurgitation). This means your valve has trouble fully closing. This results in some blood leaking backward into your heart instead of moving forward into your aorta. This forces your heart to work harder to pump out enough blood, leading to heart damage over time. That’s why people with severe aortic regurgitation and/or symptoms typically need surgery to repair or replace their valves.

Surgeons usually replace your aortic valve to fix problems like regurgitation. However, some people can benefit from repair of their aortic valve. Surgeons carefully choose the people who can have repair surgery on a case-by-case basis. They take into account many factors, including the anatomy of your valve and the extent of damage. Your surgeon will recommend either repair or replacement based on your individual needs.

What happens before aortic valve repair?

Pre-operative testing is a main part of your preparation. Your surgeon needs to make sure that your aortic valve is repairable. If parts of your valve are too damaged, then you may need a replacement valve instead of a repair. You might have a transesophageal echocardiogram (TEE) to give your surgeon a detailed, close-up look at your valve and other areas of your heart.

Other tests you may need include:

• Cardiac catheterization.
• Chest X-ray.
• Computed tomography (CT) scan.
• Electrocardiogram (EKG).
• Blood tests and urine tests.

Your provider will give you detailed instructions for how you should prepare. Follow these closely and ask if there’s anything you don’t understand. The instructions will tell you:

• When you should stop eating or drinking anything (fasting) prior to your surgery.
• If you should temporarily stop taking any of your usual medications.
• When you should arrive at the hospital for your surgery.
• What you should bring with you and what you should leave at home.

How is an aortic valve repair done?

Surgeons perform aortic valve repair through open-heart surgery or, in some cases, minimally invasive surgery. Open-heart surgery involves one large cut (incision) in the middle of your chest. Minimally invasive surgery uses smaller incisions to access your heart and repair your valve. Your surgeon will let you know which method is more suitable for you.

In general, aortic valve repair follows these steps:

1. You receive medication (anesthesia) that puts you into a deep sleep. You won’t be awake or feel pain during the surgery.
2. Your surgeon makes one or more incisions in your chest to access your heart. This may involve making one long cut (about six inches) through your breastbone (sternotomy). Or your surgeon may make smaller two- to four-inch incisions without opening your whole chest.
3. Your surgeon connects you to a heart-lung machine. This device does the work of your heart and lungs during the surgery.
4. Your surgeon repairs your valve according to your individual needs. They can use many different techniques to do this depending on the anatomy of your valve and which parts are damaged. For example, they may do an annuloplasty to reinforce your valve and help it close more tightly. Other techniques include reshaping your valve leaflets or applying tissue patches to tears or holes in them.
5. Your surgeon fixes other issues, like aneurysms, as needed. For example, they may repair abnormally widened sections of your aortic root or ascending aorta.
6. When all the necessary repairs are complete, your surgeon closes your incision(s), and your care team moves you to recovery.

What happens after this surgery?

You can expect to spend about three to seven days in the hospital. Your care team will keep a close eye on you and make sure you’re recovering normally. They’ll help you get moving slowly and safely.

Before you go home, you’ll learn about cardiac rehab and how it can help you continue your recovery.

What are the benefits of this procedure?

The main benefit of aortic valve repair is that it allows you to keep your natural (native) valve. This means you can avoid many of the risks associated with valve replacement, including the potential need for long-term blood thinners (anticoagulants). Your provider can tell you more about the benefits of repair over replacement in your specific situation.

What are the risks of this procedure?

Aortic valve repair is a serious operation that carries some risks. One possible complication is the need for another surgery. You may need another surgery for additional repairs or a valve replacement if:

• Your valve continues leaking after surgery (recurrent aortic regurgitation).
• Your valve becomes infected (endocarditis).
• Parts of your valve don’t work as expected after the repair.

Other possible complications of any aortic valve surgery include:

• Abnormal heart rhythm (arrhythmia).
• Allergic reaction to anesthesia.
• Bleeding.
• Heart attack.
• Heart failure.
• Stroke.

Everyone has different levels of risk. Your surgeon will talk to you about your risks before surgery. It’s important you understand all possible complications and how they may affect you. Ask if anything is unclear. People who have serious health issues prior to the surgery (for example, people with severe heart failure) may face higher risks.

What is the recovery time for aortic valve repair?

You’ll likely need about four to eight weeks to recover from your surgery. You may need less time if you have minimally invasive surgery (smaller incisions).

It’s normal to feel tired for several weeks. Take it easy and don’t try to do too much, too fast. Your provider will tell you when it’s safe for you to return to your usual activities, including driving and going back to work. Participating in cardiac rehab can also help you safely get moving again while also making healthy lifestyle changes.

When should I call my healthcare provider?

Call your healthcare provider right away if you have signs of complications after your surgery, including:

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

How common is aortic valve repair?

Aortic valve repair is much less common than aortic valve replacement. Researchers estimate that less than 5% of all aortic valve surgeries involve valve repair. This is largely because aortic valve repair is a highly specialized type of surgery. It’s not widespread among many hospitals and surgeons.

What conditions are treated with aortic valve repair?

Aortic valve repair surgery treats aortic regurgitation (leaky valve).

Surgeons sometimes perform aortic valve repair as an isolated procedure. This means the only problem is a leaky valve, and the repair will address that problem.

Surgeons can also repair your aortic valve during valve-sparing aortic root replacement. This surgery treats an aneurysm (abnormal widening) in the part of your aorta that attaches to your heart. Your surgeon removes damaged parts of your aorta and also repairs your aortic valve. This approach allows you to keep your natural valve and avoid a valve replacement.

In both cases, your surgeon uses highly specialized techniques to give your valve the ability to work normally. It’s best to have aortic valve repair at a high-volume hospital with surgeons experienced in this technique.

A note from Cleveland Clinic

Aortic valve repair is a major surgery, so you may be nervous about the process and wonder how you’ll feel after. But in an experienced surgeon’s hands, your heart can get the care it needs to work better and stronger in the long run. As you prepare for your surgery, share all of your questions and concerns with your healthcare team. They’ll explain what you can expect and connect you with resources to learn more.