Aortic Valve Surgery: Types, Procedure, & Recovery: Types, Procedure, & Recovery

The heart contains four valves that control blood flow, with the aortic valve being one of them. It is located between the heart’s left chamber and the aorta, the primary artery responsible for transporting oxygen-rich blood throughout the body. These valves function to keep blood flowing in the proper direction within the heart.

When the heart contracts, the aortic valve opens to allow blood to move from the left chamber into the aorta. As the heart relaxes, the valve closes to stop blood from flowing backwards. If the valve becomes damaged or diseased, it disrupts this process, forcing the heart to work harder to maintain circulation.

Some people have congenital heart defects that affect valve function. Aortic valve surgery can correct these issues and help reduce the possibility of complications associated with valve disease.

This surgery is used to treat conditions such as aortic valve regurgitation, where the valve leaks, or aortic valve stenosis, where the valve opening becomes too narrow. Depending on the case, surgeons may perform either open-heart surgery or a minimally invasive approach that uses smaller incisions and promotes quicker recovery.

Types of Surgery

There are two main types of aortic valve surgery:

• Aortic Valve Repair, where the surgeon preserves as much of the natural valve as possible and fixes the damaged areas.
• Surgical Aortic Valve Replacement (SAVR) involves removing the damaged valve and implanting a new one.

The type of surgery is determined by various factors, such as the patient’s age, medical history, heart anatomy, and results from diagnostic tests. The surgeon will explain all available options and recommend the most suitable treatment plan.

Diagnosis

Diagnosing aortic valve disease involves your doctor asking about your health history and current symptoms. Your cardiologist may hear a whooshing sound, known as a heart murmur, when listening to your heart with a stethoscope.

The tests listed below are customized for each patient, and not all diagnostic tests may be included.

• Echocardiogram: An echocardiogram uses sound waves to create moving images of the heart. It shows how blood flows through the heart and the valves. This can help assess the severity of the valve disease.
• Electrocardiogram (ECG or EKG): The ECG records the electrical activity of the heart. Through this, we understand how the heart is beating. Electrode patches are applied to the chest and legs. A wire connects the patches to a computer that will print the results.
• Chest X-ray: A chest X-ray reveals the condition of the heart and lungs. It will indicate if the heart is enlarged, which is a sign of aortic valve disease or heart failure.
• Cardiac MRI: Cardiac MRI scans generate detailed images of the heart by utilizing powerful magnets and radio frequency signals. This test helps assess how severe the aortic valve disease is and measures the aorta’s dimensions.
• Cardiac computerized tomography (CT) scan: A CT scan captures detailed images of the heart and valves by combining multiple X-ray images. The test helps evaluate the aorta’s size and provides a closer view of the aortic valve. A CT scan can assess how severe the aortic valve stenosis is.
• Exercise or stress tests: These tests monitor heart activity with an ECG while you exercise on a treadmill or stationary bike. This helps to see how the heart reacts to physical activity and whether you have valve disease symptoms during exercise.
• Cardiac catheterization: This test is used infrequently to assess the severity of aortic valve disease and to diagnose conditions that other tests cannot. A slender, flexible tube is threaded through a blood vessel in the arm or groin and directed toward the heart. This provides more details about blood flow and the heart’s dynamics, as well as its overall functioning.

Treatment Options

The treatment involves aortic valve surgery. Doctors will use an anaesthetic to put you in a sleep-like state before surgery. During the surgery, a heart-lung bypass machine will take over the function of your heart and lungs. This machine will keep the blood pumping through your body during the aortic valve surgery. The surgery done could be either one of the following:

Open-heart surgery: A surgical cut called an incision will be made through the middle of the chest to reach the heart. Minimally invasive heart surgery involves making smaller incisions. It uses a “J” incision. This type of surgery does not involve cutting any significant muscle or breaking any bones. Resultantly, you may have a faster recovery.

If you have very mild symptoms, you may not need surgery. Instead, you may be prescribed medications to manage the symptoms. You may be prescribed blood thinners or blood pressure medications. Some people may be prescribed antiarrhythmics or medications that manage their heart’s rhythm.

Surgery Procedure

• Aortic valve repair: This is done with an open-heart surgery. The surgery may involve patching holes or tears in the aortic valve cusps, adding support to the roots of the valve, separating valve cusps that have connected together, removing tissue to allow the valve to close more tightly, and reinforcing the annulus, which is a ring around the valve.
• Transcatheter aortic valve implantation: This is also called balloon valvuloplasty and is done to repair the valve. A narrow, pliable tube called a catheter is introduced into a blood vessel in the arm or groin. It is then guided to the diseased aortic valve. A balloon located at the catheter’s tip is inflated to widen the valve opening.
• Aortic valve replacement: The surgeon takes out the aortic valve and installs a mechanical replacement. Sometimes a valve made with cow, pig, or human tissues is used.

Recovery and Outlook for Surgery

Your recovery depends on your specific heart condition and the type of procedure you have had. You will be given fluids and medicines through IV. You may also be given oxygen through a mask. As you recover, the healthcare team looks for any signs of infection and checks that your breathing, blood pressure, and heart rate are normal. You will be asked to walk regularly. You may have to stay in the hospital for five to seven days.

Post your discharge, you will be told not to drive or lift anything very heavy for six weeks. You will also have to go for regular follow-up appointments with the doctor. Imaging tests will be done to ensure that the valve is working correctly. If you have a mechanical valve, you may have to take blood thinners for life to prevent clots. You will be recommended to eat a healthy, balanced diet, engage in regular exercise, manage stress, and stop smoking or using tobacco.

What to Consider Before and After Aortic Valve Surgery

Discuss the risks and benefits of aortic valve surgery with your doctor. Understand what is involved and what the outlook will be after the surgery. As the surgery is being planned, consider discussing it with friends and family. Seek help to prepare and recover. It is essential to have a support system nearby to help you recover physically and emotionally from a significant life event.

Benefits

Aortic valve surgery offers many important benefits.

• It helps fix problems in the heart valve and improves overall health.
• One major benefit is better blood flow. A repaired or replaced valve allows the heart to pump blood more smoothly throughout the body.
• The surgery also helps reduce symptoms. Many people feel less chest pain, shortness of breath, tiredness, and dizziness after the procedure.
• It can lower the risk of serious problems such as heart failure, stroke, or sudden cardiac arrest. In many cases, the surgery can be life-saving.
• Another key benefit is an improved quality of life. After recovery, people often have more energy and can return to their daily activities with ease.

Overall, aortic valve surgery can help you live longer and feel better.

Complications

Aortic valve surgery is generally safe, but like any surgery, it has some risks. Doctors take many precautions to reduce these risks.

Some common complications may include:

• Bleeding during or after the surgery
• Infection at the surgical site or inside the body
• Blood clots, which can lead to serious problems
• Stroke, caused by blocked blood flow to the brain
• Heart attack during or after the procedure
• Irregular heartbeat (arrhythmia), which is often temporary

Other possible risks are:

• Kidney problems, usually temporary
• Breathing issues or lung infections
• Problems with the new valve, which may need further treatment

The risk level can vary from person to person. It depends on factors such as age, general health, and the kind of surgery performed.

Your doctor will explain your risks before the procedure and guide you on how to reduce them.

Frequently Asked Questions