Aortic Valve Repair or Replacement

Aortic valve repair and aortic valve replacement are both forms of heart valve surgery performed to address a damaged or diseased aortic valve, one of the four valves responsible for regulating blood flow within the heart. Positioned between the lower left heart chamber and the body's main artery, the aorta, the aortic valve plays a crucial role in ensuring blood flows in the correct direction through the heart. During each heartbeat, the aortic valve opens as the heart contracts, allowing blood to move from the lower left heart chamber into the aorta. Subsequently, as the heart relaxes, the valve closes to prevent blood from flowing backward.

Any impairment to the valve can disrupt blood flow, necessitating the heart to exert more effort to pump blood throughout the body.

Aortic Valve Replacement

What is an aortic valve replacement? Aortic Valve Replacement (AVR) is a surgical procedure that involves replacing a damaged aortic valve with an artificial one. Positioned between the heart’s left ventricle and the aorta, the aortic valve ensures proper blood flow from the heart to the rest of the body. Conditions like aortic stenosis and aortic regurgitation can impair valve function, causing symptoms such as shortness of breath, chest pain, and fatigue. If left untreated, these issues may progress to heart failure.

Aortic valve repair and aortic valve replacement are done to treat aortic valve disease. Types of aortic valve disease that may need valve repair or replacement include:

Aortic valve regurgitation. The aortic valve doesn't close properly, causing blood to flow backward into the left lower heart chamber. Any condition that damages the aortic valve can cause regurgitation. Sometimes, a baby is born with an irregularly shaped aortic valve that leads to regurgitation.
Aortic valve stenosis. The aortic valve flaps, called cusps, become thick and stiff, or they connect together. The valve becomes narrowed or doesn't open fully. This reduces or blocks blood flow. Aortic valve stenosis may be caused by a heart condition present at birth or some infections affecting the heart valve.
Other aortic valve problems present at birth are called congenital heart defects. Some babies may be born with an aortic valve that's missing a valve opening or have two valve cusps instead of three. A congenital heart defect can also cause the valve to be the wrong size or shape.
You might need aortic valve surgery if your valve disease affects your heart's ability to pump blood.
If you don't have symptoms or your condition is mild, your healthcare team might suggest regular health checkups, lifestyle changes, and medicines. But most aortic valve conditions eventually need surgery to reduce symptoms and lower the risk of complications such as heart failure.

Types of Aortic Valve Replacement

There are two primary types of aortic valve replacement:

Traditional aortic valve replacement (open-heart surgery): This standard approach requires opening the chest to access the heart, where the damaged aortic valve is removed and replaced with either a mechanical or biological valve. Mechanical valves offer durability but require lifelong blood thinners, while biological valves, made from animal tissue, do not necessitate long-term blood thinners but may have a shorter lifespan.
Minimally invasive aortic valve replacement: This approach uses smaller incisions and specialized instruments to replace the aortic valve, reducing recovery time and less postoperative discomfort.

The decision to repair or replace a damaged aortic valve depends on many things, including:

The severity of aortic valve disease is also called the stage of disease.
Age and overall health.
Whether surgery is needed to correct another valve or heart condition.
In general, surgeons recommend valve repair when possible. It lowers the risk of infection, saves the heart valve, and may help the heart work better. The best option depends on the specific aortic valve disease, as well as the expertise and experience of the healthcare team.

Aortic Valve Repair

What is an aortic valve repair? Aortic valve repair is usually done with open-heart surgery and by opening the chest bone, a procedure called a sternotomy. Surgeons wire the bone back together after the procedure. During aortic valve repair surgery, the heart surgeon might:

Patch holes or tears in the aortic valve cusps.
Add support at the base or roots of the valve.
Separate valve cusps that have connected together.
Reshape or remove tissue to allow the valve to close more tightly.
Tighten or reinforce the ring around the valve, called the annulus.

Types of Aortic Valve Repair

Minimally invasive aortic valve repair. In some people with a narrowed aortic valve, a minimally invasive treatment called balloon valvuloplasty may be done to repair the valve. It uses much smaller surgical cuts than open-heart surgery. It does not require opening the chest bone.
Balloon valvuloplasty. During balloon valvuloplasty, the heart doctor places a thin, flexible tube called a catheter into an artery in the arm or groin. The tube is guided to the diseased or damaged aortic valve. A balloon on the tip of the catheter is inflated, which makes the valve opening larger. The balloon is deflated. The catheter and balloon are removed. Balloon valvuloplasty is often used to treat infants and children with aortic valve stenosis. The aortic valve tends to narrow again in adults who have had the treatment. So, balloon valvuloplasty is usually only done in adults who are too ill for surgery or who are waiting for a valve replacement.

Benefits of Aortic Valve Repair or Replacement

Aortic valve replacement or repair can offer numerous benefits for individuals with aortic valve disease, such as:

By replacing or repairing a diseased or malfunctioning aortic valve, the heart can function more efficiently, leading to better overall cardiac performance.
Aortic valve surgery can alleviate symptoms associated with aortic valve disease, such as chest pain, shortness of breath, fatigue, and dizziness, thereby enhancing quality of life.
Addressing aortic valve issues promptly through surgery can help prevent potential complications like heart failure, arrhythmias, and other severe cardiovascular conditions.
After valve replacement or repair, individuals often experience improved exercise capacity, allowing for a more active and healthier lifestyle.
A successful aortic valve procedure can significantly increase life expectancy by reducing the risks of untreated valve disease, such as heart failure or stroke.
Aortic valve surgery can lower the risk of developing infective endocarditis, a potentially life-threatening infection of the heart valves.
Overall, aortic valve replacement or repair can improve quality of life by relieving symptoms, improving heart function, and reducing the risk of complications associated with aortic valve disease.

Risks of Aortic Valve Repair or Replacement

All surgeries have risks. Risks of aortic valve repair and replacement depend on many things, including:

Your overall health.
The specific type of valve surgery.
The expertise of the surgeons and other healthcare professionals.

To reduce potential risks, aortic valve surgery should generally be done at a center with a multidisciplinary heart team experienced in such procedures and that does many aortic valve surgeries.

Possible risks of aortic valve repair and aortic valve replacement surgery may include:

Bleeding.
Blood clots.
Problem or failure of a replacement valve.
Irregular heartbeats, called arrhythmias.
Infection.

Before the procedure: Body hair in the area where surgical incisions will be made may need to be shaved. Additionally, a special soap could be utilized to cleanse your skin and reduce the risk of infection.

During the procedure: You receive medicine called an anesthetic to put you in a sleep-like state during the surgery. You are connected to a heart-lung bypass machine. The machine keeps blood moving through the body during the aortic valve surgery.

Aortic valve repair and aortic valve replacement may be done as follows:

Open-heart surgery. This involves making a surgical cut, called an incision, through the middle of the chest to reach the heart.
Minimally invasive heart surgery. This involves much smaller incisions than those used in open-heart surgery. Minimally invasive surgery usually does not require cutting any significant muscle or breaking any bones. Transcatheter aortic valve replacement (TAVR) is minimally invasive heart valve surgery. Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery, and less pain than traditional open-heart surgery.

After the procedure: The length of hospital stay following aortic valve surgery varies based on the particular heart condition and type of procedure performed.

While hospitalized, you will receive fluids and medications intravenously. Urinary drainage tubes and chest tubes are utilized to remove urine, fluid, and blood. Oxygen may be administered through a mask or a nasal tube.

Throughout your hospitalization, your healthcare team will do the following:

Monitor your condition for signs of infection
Assess your blood pressure, breathing, and heart rate
Assisting with pain management
Encourage regular walking to increase activity levels gradually
Recommend coughing and breathing exercises for recovery

The duration of your recovery will vary based on the type of aortic valve repair or replacement performed.

Results of Aortic Valve Repair or Replacement

Following aortic valve repair or replacement surgery, your healthcare team will provide guidance on when you can resume your regular activities.

Restrictions such as refraining from driving or lifting anything over 10 pounds may be advised for several weeks.

Regular follow-up appointments with your healthcare provider are essential, with imaging tests conducted to monitor the functionality of the aortic valve.

If you have a mechanical valve, lifelong blood thinner medication is necessary to prevent blood clots, whereas biological valves may require eventual replacement due to wear and tear. While mechanical valves are durable over time, some replacement valves may develop issues like leakage, necessitating repair procedures.

Lifestyle changes such as maintaining a healthy diet, exercising regularly, managing stress, and avoiding tobacco use are recommended to support heart health.

Your care team may also recommend participation in a personalized cardiac rehabilitation program to enhance heart health post-surgery, focusing on exercise, diet, stress management, and gradual reintegration into daily activities.