Aortic Valve Replacement

What is the aortic valve?

The aortic valve is one of the four heart valves. It typically has three leaflets. When the heart contracts, oxygenated blood is ejected and flows through this valve to the rest of the body. An abnormal aortic valve may either leak (insufficiency/regurgitation) or be too tight (stenosis). Either problem may be severe enough to require valve replacement.

What are the symptoms of aortic valve problems?

Aortic regurgitation will eventually lead to enlargement of the heart and heart failure symptoms, such as shortness of breath with activity or lying flat. Aortic stenosis may be asymptomatic but can cause symptoms such as chest pain (angina), fainting (syncope), shortness of breath or heart failure. With severe aortic stenosis, there is a 2% incidence of sudden death each year and, once symptoms appear, there is almost a 50% chance of dying within two years.

How is the operation performed?

Your primary care doctor may discover a murmur while listening to your heart. An echocardiogram is then typically ordered to assess whether your valves are stenotic or regurgitant, and the size and function of your heart. Your valve disease will then be quantified as mild, moderate or severe.

How is this diagnosed?

Aortic valve replacement (AVR) can be performed through a median sternotomy, minimally invasively using an anterior thoracotomy incision or hemisternotomy, or percutaneously (transfemorally or transapically) for patients who are not candidates for traditional aortic valve replacement. For traditional AVR, the patient is placed on the heart–lung machine, the heart is stopped and the valve excised, and a new prosthetic valve is sewn into place. The valve may be replaced with a mechanical valve or a bioprosthesis (tissue valve), depending on the needs of each individual. Your surgeon will discuss the particular pros and cons of the different types of valves, and the best operative approach for you.

What should I expect after the surgery?

The procedure takes approximately two to three hours. Then you are taken directly to the intensive care unit (ICU). You will have chest tubes and temporary pacemaker wires, which are typically removed by postoperative day 2 or 3. While in the hospital, your activity is increased slowly each day. Discharge from the hospital usually occurs by postoperative day 3 to 5. Physical therapists, in conjunction with your doctors and nurses, will determine if you will be discharged home with home health assistance or to a rehabilitation facility. You will be given detailed instructions upon discharge concerning diet, medications, incision care, sternal precautions, signs and symptoms of an infection or other potential problems, and activity level. You will follow up with your surgeon three to four weeks after discharge and typically may resume driving and light work duty (no lifting greater than 10 pounds for two to three months, depending on your operative approach). You will then follow up with your cardiologist, who will send you to outpatient cardiac rehab.

What are the risks associated with the procedure?

There is about a 4% (4 out of 100) chance of having a complication, including but not limited to infection, bleeding requiring reoperation, stroke, organ system failure such as lungs requiring prolonged ventilation, kidneys requiring either temporary or permanent dialysis, heart attack around the surgery, heart failure, prolonged ICU course, or heart block requiring a permanent pacemaker. Chance of death is about 2%. These percentages are based on national averages.