Aortic Valve Replacement
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Aortic Valve Replacement

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Definition

Aortic valve replacement is an open-heart surgery. It is done to replace a malfunctioning aortic valve with a new one. The replacement valve may be:

  • Mechanical–made entirely out of artificial materials
  • Bioprosthetic–engineered out of a combination of artificial materials and tissues from a pig, cow, or other animal
  • Homograft or allograft–harvested from a donated human heart
  • Ross procedure (self-donated)–in selected patients less than 50 years of age, another one of the patient’s own heart valves, the pulmonic valve, may be removed from its original location and sewn in to take the place of the faulty aortic valve. A homograft is then sewn in to take the original place of the pulmonic valve.

Parts of the Body Involved

Aortic Valve–Opened and Closed

Nucleus image

© 2008 Nucleus Medical Art, Inc.

The aortic valve is located between the pumping chamber (ventricle) on the left side of the heart and the aorta (a major artery). The aorta carries oxygen-rich blood from the heart so that it can move through the body. The valve should be closed while the heart is filling with blood. When the heart chamber squeezes to push blood into the aorta, the valve should open fully to allow blood flow.

Reasons for Procedure

Aortic valve replacement is performed when the aortic valve is not working properly. The amount of oxygen rich blood getting out to the body can be significantly decreased with a faulty valve.

Sometimes, the aortic valve is misshapen due to a birth defect. This is called congenital aortic valve disease. Other times, the aortic valves work well for years before becoming too stiff or too floppy to open and close fully. This is called acquired aortic valve disease. Sometimes this happens due to normal aging. With age, calcium build-up on the valves causes them to malfunction. The valve problem may also occur as a result of other conditions, such as:

  • Rheumatic valve disease ( rheumatic fever)—a complication of streptococcal throat infection, which can damage the valve.
  • Endocarditis—an infection inside the heart that involves the valves.
  • Aortic aneurysms—an abnormal widening or outpouching of the aortic artery.
  • Aortic dissection—bleeding into the wall of the artery, usually due to the presence of an aortic aneurysm.
  • Aortic valve stenosis—the valve is too stiff to open fully, the heart may have a hard time pumping blood into the aorta. The problem may become severe enough to require surgery.
  • Aortic valve regurgitation—the valve is too floppy to close fully. There may be a backwash of blood flow from the aorta that leaks back into the heart. The problem may become severe enough to require surgery to replace the faulty aortic valve.

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Prior to the procedure, your doctor will likely perform the following:

  • Physical exam
  • Blood tests—to make sure that you do not have an infection, to make sure that your blood is clotting properly, and to determine your blood type in case you need a transfusion during or after surgery
  • Echocardiogram—a test that uses sound waves to produce a moving picture of your heart and its valves
  • Electrocardiogram—a test of the electrical system of your heart
  • Cardiac catheterization—a test in which a very thin tube is threaded up through your aorta. Dye is squirted through the catheter, and digital images are captured. These images can reveal problems with the functioning of your aortic valve and also determine whether your heart arteries are unobstructed and free from disease.

In the days leading up to your procedure:

  • Review your regular medications with your surgeon. You may need to stop taking certain drugs.
  • Do not eat or drink anything after midnight the night before your surgery, unless told otherwise by your doctor.
  • Arrange for help at home after you return from the hospital.
  • Arrange to have someone drive you home when you leave the hospital.
  • Wear comfortable clothing.

Anesthesia

Aortic valve replacement is performed under general anesthesia . You will usually be given medications through an intravenous line to help you relax.

Description of the Procedure

  • You will be completely under the anesthetic before surgery begins.
  • An incision will be made down the middle of your chest, and your breastbone will be separated so that your heart can be accessed.
  • You will be put onto a heart-lung machine. During the course of the operation, this machine will do the work usually performed by your heart and lungs. This allows your heart to be stopped so that it can be operated on more easily.
  • Another incision is made in the aorta.
  • The damaged valve is cut out, and a new valve is sewn into place.
  • The aorta is sewn back together.
  • The heart is started up again. The heart-lung machine can be withdrawn from use.
  • The breastbone is wired together.
  • The skin incision in the chest is sewn back together.

After the Procedure

You’ll be monitored in an intensive care unit directly after surgery. When you awaken, you’ll notice that you are attached to a number of devices, including:

  • Monitors to track your heart rate, breathing rate, blood pressure, and the percentage of oxygen in your bloodstream
  • Ventilator tube in your mouth and into your lungs to breathe for you, or an oxygen mask or tube to give you extra oxygen
  • Tubes to drain extra fluid from your chest
  • A tube that goes into your nose and down to your stomach that drains your stomach of excess fluid and gas
  • A catheter in your bladder to drain urine
  • An intravenous line to provide fluids, electrolytes, and pain medications directly into a vein

How Long Will It Take?

Aortic valve replacement surgery takes about 2-4 hours to complete.

Will It Hurt?

During the surgery, you will not feel pain because you will be under a general anesthetic. Because aortic valve replacement surgery requires a major incision in the chest, there will be pain after the surgery. You will be given pain medication for a number of days after surgery to make you as comfortable as possible.

Possible Complications

  • Infection of the skin or breastbone incision
  • Bleeding
  • Arrhythmias or irregular heart beats. Particularly atrial fibrillation.
  • Complications from anesthesia
  • Pneumonia
  • Scarring
  • Blood clots in the new valve, which can travel through the body—if these clots obstruct blood vessels in the body, depriving tissues of oxygen, severe complications can result, such as a stroke or kidney damage
  • Mechanical problems with the valve’s functioning
  • Endocarditis (infection of a heart valve)
  • Pericarditis (inflammation of the sac around the heart)
  • Phlebitis (inflammation of a vein)

Average Hospital Stay

You will usually be in the intensive care unit for 1-2 days. Then you will be moved to a regular hospital room, where you will stay for several more days. Depending on how you progress and on how debilitated you were prior to surgery, you may also spend some time in a cardiac rehabilitation program.

Postoperative Care

  • You will probably be given a device called an incentive spirometer which you will use every couple of hours during the day. This makes sure that you are breathing deeply and keeping the tiny sacs within your lung as open as possible. This can help you avoid the complication of pneumonia.
  • You will be allowed to walk within 24 hours of your surgery.
  • If you have a mechanical valve, you will have to take blood-thinning medications (anticoagulants) for the rest of your life to avoid developing clots around the valve.
  • You will need to take an antibiotic whenever you have dental procedures or certain surgical and endoscopic procedures.

Outcome

You can expect to be able to resume your normal activities within about six weeks of surgery. You should follow your doctor’s directions regarding when you can begin to drive, exercise, lift things, and otherwise exert yourself.

Call Your Doctor If Any of the Following Occurs

  • Fever, chills
  • Cough, especially if it’s productive
  • Shortness of breath
  • Chest pain
  • Redness, swelling, or hotness around the site of your incision; discharge from the site of the incision
  • Nausea, vomiting
  • Difficulty urinating, or pain, burning, frequency, urgency, or bleeding with urination
  • Pain and/or swelling in your feet, calves, or legs

RESOURCES:

American Heart Association
http://www.americanheart.org

Cleveland Clinic Heart Center
http://www.clevelandclinic.org

The Society of Thoracic Surgeons
http://www.sts.org

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

Mount Sinai Hospital, Canada
http://www.mtsinai.on.ca

References:

Townsend CM et al., (eds). Sabiston Textbook of Surgery . 17th edition. St. Louis, MO: WB Saunders Co.; 2004.

Zipes DP., ed. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 7th edition. St. Louis, MO: WB Saunders Co.; 2005.



Last reviewed March 2008 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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