Aortic Valve Repair / Replacement
Blood flow in the heart is regulated by four valves, ensuring there is
blood moving in every direction through the heart. The aortic valve is
responsible for moving blood from the heart's left ventricle, the
main pumping chamber, to the rest of the body through the aorta, the body's
If the aortic valve is not functioning properly, it leads to issues with
overall blood flow and forces the heart to work harder and faster to supply
blood to the body. Symptoms of aortic valve dysfunction may include shortness
of breath, chest pain, irregular heartbeat, fatigue, and loss of consciousness,
although some people may experience no symptoms at all. As the condition
progresses, the risk of serious complications such as heart attack, stroke,
heart failure, and sudden cardiac arrest increases.
Once aortic valve disease has been diagnosed, treatment is typically focused
on restoring blood flow through the aortic valve to preserve heart function
and to reduce symptoms and potential complications.
Types of Aortic Valve Disease
Most cases of aortic valve disease involve mechanical issues with the valve
that can only be resolved with surgery (aortic valve repair or replacement).
Treatment options depend on the type of aortic valve disease, severity
of the condition, and symptoms.
These are the primary types of aortic valve disease:
Aortic Valve Stenosis – Narrowing of the aortic valve, known as aortic valve stenosis,
restricts blood flow from the left ventricle to the aorta. While this
does not always produce symptoms, it can lead to chest pain, fainting,
breathlessness, palpitations, heart murmur and a decline in activity level.
Aortic Valve Regurgitation – Blood normally flows in one direction, from the left ventricle
to the aorta, through the aortic valve. In people who have aortic valve
regurgitation, the blood flows backwards due to a leaky or dysfunctional
valve. This can cause symptoms such as heart palpitations, chest pain
or shortness of breath.
Congenital Heart Disease – Individuals may be born with congenital heart defects that result
in aortic valve regurgitation or aortic valve stenosis, as well as other
issues affecting the aortic valve's ability to work properly.
Repair vs. Replacement
In order to determine whether an aortic valve should be repaired or replaced,
it is important to consider multiple factors including the severity of
the aortic valve disease, the patient’s age, the presence of other
medical conditions, and the results of diagnostic tests.
Aortic valve repair and replacement can be done traditionally, through
open heart surgery, or through minimally invasive methods. During traditional
aortic valve surgery, an incision is made down the center of the sternum,
giving direct access to the heart. Minimally invasive surgery involves
a few smaller incisions in the chest or the use of a catheter in the chest
or leg. The use of minimally invasive methods has been shown to reduce
blood loss in surgery, accelerate recovery time, and reduce complications.
Aortic Valve Repair
Aortic valve repair is usually the first choice of treatment because it
has a lower risk of infection, reduces the need for blood thinners, and
preserves valve strength. However, this surgery is often more difficult
to perform and not all valves can be repaired.
Repairing the aortic valve is typically done using the traditional open-heart
surgery method. There are a few different types of repair procedures that
may be done including:
- Inserting an artificial ring (annuloplasty) to reinforce the ring around
the valve (annulus)
- Separating valve cusps that have fused
- Reshaping tissue to allow the valve to close more tightly
- Inserting tissue to patch any tears in the flaps used to close off the valve
- Adding support at the base of the valve
Aortic Valve Replacement
During aortic valve replacement, the original faulty valve is removed and
is replaced with either a biological or mechanical valve. Procedures may
be done through traditional open-heart surgery methods or a minimally
Biological valve replacement – Uses the tissue of a cow, pig, or human donor to replace existing valve
tissue. While these valves last about 15-20 years, they often have to
be replaced due to degeneration over time.
Mechanical valve replacement
– Involves the creation of a valve from non-reactive mechanical parts that
are well tolerated by the body. Patients must take blood thinning medication
for the rest of their lives to reduce the risk of blood clotting or stroke.
Transcatheter aortic valve replacement (TAVR) – This is a minimally invasive approach that involves the doctor
accessing the heart through a small incision in the chest or a blood vessel
in the leg. During TAVR, a catheter is guided through a vein to the existing
aortic valve which is then replaced with a new self-expanding valve.
The risks involved in aortic valve repair or replacement surgery vary depending
upon a patient's overall health and other factors. Potential risks include:
- blood clots
- heart rhythm issues
- problems with the replacement valve
As a general rule of thumb, patients spend a day or more in the intensive
care unit (ICU) following aortic valve surgery. While there, they’ll
receive oxygen, fluids, nutrition, medication, and close medical supervision.
After a few days, patients are moved out of ICU and into a general hospital
room. During this time, medical staff will monitor for infection at the
incision site(s), manage any post-surgery pain, and periodically check
heart rate, breathing, and blood pressure. Patients will also engage in
daily walking and breathing exercises to promote recovery.
What to Expect After Surgery
Once home, patients should be able to gradually re-engage in daily activities
such as driving, working, and exercising, although the timeline for introducing
activity will vary from person to person. Patients will need to take prescribed
medications and keep follow up medical appointments. Doctors may also
recommend healthy lifestyle changes such as physical activity, healthy
eating, stress management, and avoiding tobacco use.
Download the Preparing for Heart Surgery Guide