What is Aortic Valve Repair and Aortic Valve Replacement? Purpose, Procedure & Results

Aortic valve repair and replacement are heart procedures that fix problems with your aortic valve, the gateway between your heart and the rest of your body. When this valve doesn't work properly, your heart has to work much harder to pump blood, which can lead to serious health issues over time.

Think of your aortic valve like a one-way door that opens to let blood flow from your heart to your body, then closes to prevent blood from flowing backward. When this door becomes too narrow, too leaky, or doesn't open and close properly, surgery can help restore normal blood flow and ease the strain on your heart.

What is aortic valve repair and aortic valve replacement?

Aortic valve repair means fixing your existing valve to help it work better. During repair, your surgeon adjusts or reconstructs parts of your natural valve while keeping the original valve in place. This approach preserves your body's own tissue whenever possible.

Aortic valve replacement involves removing your damaged valve and putting in a new one. The replacement valve can be either mechanical (made from durable materials like metal and carbon) or biological (made from animal or human tissue). Your surgeon will discuss which option works best for your specific situation.

Both procedures aim to restore normal blood flow through your heart. Repair is often preferred when possible because it keeps your natural valve, but replacement becomes necessary when the damage is too extensive to fix.

Why is aortic valve repair and replacement done?

These procedures treat two main problems with your aortic valve: stenosis and regurgitation. Aortic stenosis happens when your valve becomes narrow and stiff, making it hard for blood to flow out of your heart. Aortic regurgitation occurs when your valve doesn't close properly, allowing blood to leak back into your heart.

Without treatment, these conditions force your heart to work overtime. Over months or years, this extra strain can weaken your heart muscle and lead to heart failure. You might experience chest pain, shortness of breath, dizziness, or fatigue as your heart struggles to pump blood effectively.

Your doctor might recommend surgery if your symptoms are affecting your daily life or if tests show your heart function is declining. Sometimes surgery is suggested even before symptoms appear, especially if the valve problem is severe and likely to worsen.

The goal is to fix the problem before it causes permanent damage to your heart. Early intervention often leads to better outcomes and can help you return to your normal activities with improved energy and comfort.

What is the procedure for aortic valve repair and replacement?

The specific steps depend on whether you're having traditional open-heart surgery or a minimally invasive approach. Most aortic valve procedures are done under general anesthesia, so you'll be completely asleep throughout the surgery.

During traditional open-heart surgery, your surgeon makes an incision down the center of your chest and temporarily stops your heart using a heart-lung machine. This machine takes over the job of pumping blood and adding oxygen while your surgeon works on your valve.

For valve repair, your surgeon might separate fused valve leaflets, remove excess tissue, or add a support ring to help the valve close properly. The exact technique depends on what's causing your valve to malfunction.

For valve replacement, your surgeon removes the damaged valve and sews the new one into place. If you're getting a mechanical valve, you'll need to take blood-thinning medication for life. Biological valves typically don't require long-term blood thinners but may need replacement after 10-20 years.

Minimally invasive approaches use smaller incisions and specialized instruments. Some procedures can even be done through a catheter inserted in your leg, which means no chest incision at all. Your surgical team will determine the best approach based on your specific condition and overall health.

How to prepare for your aortic valve procedure?

Preparation typically begins several weeks before your surgery. Your medical team will run various tests to make sure you're ready for the procedure and to plan the safest approach for your specific situation.

You'll likely need blood tests, chest X-rays, an electrocardiogram, and detailed heart imaging studies. These tests help your surgeon understand exactly what's wrong with your valve and plan the best way to fix it. You might also need to see other specialists, like a lung doctor or kidney specialist, to optimize your overall health.

Your doctor will review all your medications and may ask you to stop certain ones before surgery. Blood thinners, anti-inflammatory drugs, and some supplements can increase bleeding risk during surgery. Never stop medications without discussing it with your medical team first.

Leading up to surgery, focus on eating well, getting adequate rest, and staying as active as your symptoms allow. If you smoke, quitting even a few weeks before surgery can significantly improve your healing. Your team might also recommend breathing exercises or meeting with a physical therapist to prepare your body for recovery.

How to read your aortic valve test results?

Understanding your test results helps you make informed decisions about your care. The most common test is an echocardiogram, which uses sound waves to create pictures of your heart and measure how well your valve is working.

For aortic stenosis, doctors look at the valve area and pressure gradients. A normal aortic valve area is 3-4 square centimeters. Mild stenosis shows an area of 1.5-2.0 cm², moderate stenosis is 1.0-1.5 cm², and severe stenosis is less than 1.0 cm². Higher pressure gradients indicate more severe narrowing.

For aortic regurgitation, the severity is often described as mild, moderate, or severe based on how much blood leaks backward. Your doctor will also look at how your heart muscle is responding to the extra work caused by the leaky valve.

Other important measurements include your ejection fraction, which shows how well your heart pumps blood with each beat. A normal ejection fraction is typically 55% or higher. Lower numbers might indicate that your heart muscle is being affected by the valve problem.

Your doctor will explain what these numbers mean for your specific situation. The decision for surgery isn't based on numbers alone but considers your symptoms, overall health, and risk factors together.

How to manage your condition after aortic valve surgery?

Recovery after aortic valve surgery is a gradual process that typically takes several months. Most people spend 3-7 days in the hospital, with the first day or two in the intensive care unit for close monitoring.

During your hospital stay, you'll work with nurses and physical therapists to get moving safely. Walking short distances and doing breathing exercises help prevent complications and speed your recovery. You'll also learn how to care for your incision and recognize signs of potential problems.

Once you're home, gradually increase your activities as your strength returns. Most people can return to light activities within a few weeks, but it takes 6-8 weeks for your breastbone to heal completely if you had open-heart surgery. Avoid heavy lifting during this time.

Follow-up appointments are crucial for monitoring your new or repaired valve. Your doctor will schedule regular check-ups and periodic echocardiograms to make sure everything is working properly. If you have a mechanical valve, you'll need regular blood tests to monitor your blood-thinning medication.

Cardiac rehabilitation programs can be incredibly helpful during recovery. These supervised exercise programs help you safely rebuild your strength and endurance while learning about heart-healthy lifestyle changes.

What is the best outcome for aortic valve procedures?

The best outcome is a properly functioning valve that allows you to return to your normal activities without symptoms. Most people experience significant improvement in their energy levels, breathing, and overall quality of life after successful valve surgery.

Success rates for aortic valve procedures are generally very high, with over 95% of people surviving the surgery and most experiencing excellent long-term results. The key to the best outcome is having the procedure done before your heart muscle becomes severely weakened.

With a repaired valve, you can expect it to last for many years, often for the rest of your life. Mechanical replacement valves are extremely durable and rarely need replacement, while biological valves typically last 15-20 years or longer, especially in older patients.

Your long-term outlook depends on several factors, including your age, overall health, and how well your heart muscle has recovered from the valve problem. Many people return to work, travel, exercise, and enjoy all their favorite activities after recovery.

Following your doctor's recommendations for follow-up care, taking prescribed medications, and maintaining a heart-healthy lifestyle all contribute to the best possible long-term outcome.

What are the risk factors for needing aortic valve surgery?

Several factors can increase your likelihood of developing aortic valve problems that might eventually require surgery. Age is the most common risk factor, as valve problems often develop gradually over many years of wear and tear.

Some people are born with valve abnormalities that make problems more likely later in life. A bicuspid aortic valve, where the valve has two leaflets instead of three, affects about 1-2% of people and often leads to valve problems in middle age.

Here are the main risk factors that can contribute to aortic valve disease:

• Advanced age (most common in people over 65)
• Congenital heart defects, especially bicuspid aortic valve
• History of rheumatic fever or rheumatic heart disease
• High blood pressure that puts extra strain on the valve
• High cholesterol leading to calcium buildup on valve leaflets
• Diabetes, which can accelerate valve deterioration
• Kidney disease, particularly those requiring dialysis
• Previous chest radiation therapy
• Certain autoimmune conditions
• Family history of valve disease

Having these risk factors doesn't mean you'll definitely need valve surgery, but they do increase your chances of developing valve problems. Regular check-ups can help detect issues early when treatment options are most effective.

Is it better to have valve repair or replacement?

Valve repair is generally preferred when it's technically possible and likely to provide a durable result. Repair keeps your natural valve tissue, which typically lasts longer and has a lower risk of complications compared to replacement valves.

With repair, you usually don't need long-term blood-thinning medication, which eliminates the bleeding risks associated with these drugs. Your natural valve tissue also tends to resist infection better than artificial materials.

However, repair isn't always possible or advisable. If your valve is too damaged or the repair might not last, replacement becomes the better option. Some valve problems, particularly severe calcification or certain types of structural damage, are better treated with replacement.

Your surgeon will carefully evaluate your specific situation using imaging studies and sometimes direct examination during surgery. The decision depends on factors like your age, the type and extent of valve damage, your overall health, and your personal preferences about long-term medication use.

Both repair and replacement can provide excellent results when done by experienced surgeons. The most important thing is choosing the approach that's most likely to give you the best long-term outcome based on your individual circumstances.

What are the possible complications of aortic valve surgery?

While aortic valve surgery is generally safe and successful, like any major surgery, it does carry some risks. Understanding these potential complications helps you make informed decisions and know what to watch for during recovery.

The most common complications are usually temporary and manageable with proper medical care. These might include irregular heart rhythms, temporary kidney dysfunction, or minor bleeding that requires monitoring but typically resolves on its own.

Here are the potential complications, ranging from more common to rare:

• Irregular heart rhythms (arrhythmias) that may require medication or monitoring
• Bleeding that might require blood transfusion
• Infection at the surgical site or involving the new valve
• Blood clots that could travel to other parts of the body
• Temporary kidney problems, especially in people with existing kidney disease
• Breathing problems requiring temporary breathing support
• Stroke, which is rare but more likely in people with existing risk factors
• Heart attack, particularly in people with existing coronary artery disease
• Valve problems requiring additional surgery
• Memory or thinking changes, usually temporary

The risk of serious complications is relatively low, especially when surgery is performed at experienced centers. Your surgical team will discuss your individual risk factors and take steps to minimize complications based on your specific health situation.

When should I see a doctor for aortic valve problems?

You should contact your doctor if you experience symptoms that might indicate valve problems, especially if they're new or getting worse. Early detection and treatment of valve problems often lead to better outcomes.

Chest pain, shortness of breath, dizziness, or fainting spells can all be signs of valve problems, though they can also indicate other heart conditions. Don't ignore these symptoms, especially if they occur with physical activity or seem to be getting more frequent.

After valve surgery, certain symptoms require immediate medical attention. Call your doctor right away if you develop a fever, notice increasing redness or drainage from your incision, or experience sudden chest pain or severe shortness of breath.

If you have a mechanical valve, any unusual bleeding or bruising should be reported to your doctor, as it might indicate a problem with your blood-thinning medication. Similarly, if you have any type of valve replacement, notify your doctor before dental procedures or other surgeries, as you might need antibiotics to prevent infection.

Regular follow-up appointments are essential even when you're feeling well. Your doctor can detect changes in your valve function before symptoms develop, allowing for timely intervention when treatment is most effective.