Aortic Valve Replacement Surgery

The aortic valve, the most commonly replaced valve, controls blood flow from the heart to the rest of the body. Surgical procedures, such as open-heart surgery or minimally invasive approaches, aim to treat aortic valve disease, including conditions like aortic valve stenosis and aortic valve regurgitation.

Surgeons repair or replace the valve to improve heart function, significantly enhancing blood flow and reducing symptoms. However, when treating a damaged or diseased aortic valve, repair is preferred whenever possible to help preserve the heart tissue. A replacement valve may be necessary if the tissue is severely damaged and beyond repair. Heart valve surgery is a major operation that is not suitable for everyone and involves a lengthy recovery period. However, aortic valve surgery is a lifesaving treatment that can help manage symptoms while improving patient life expectancy.

What Is Aortic Valve Replacement?

An aortic valve replacement is a surgical procedure to address issues with the heart's aortic valve. During this intervention, surgeons remove and replace a damaged or faulty valve with either a synthetic or animal tissue valve. The need for replacement typically arises due to two conditions:

Aortic valve stenosis: A condition that occurs when the valve does not open fully, narrowing and obstructing blood flow out of the heart.

Aortic valve regurgitation (aortic insufficiency): A condition that occurs when the valve does not close, allowing blood to leak or flow back into the heart instead of moving it forward and out to the body.

If left untreated, aortic valve stenosis and aortic valve regurgitation can worsen over time and may lead to life-threatening complications, such as heart failure. There are no medications that can effectively treat aortic valve problems. Surgical replacement is therefore recommended for patients at risk of serious complications.

How Is an Aortic Valve Replacement Carried Out?

A narrowed or leaky aortic valve can be replaced in two ways: minimally invasive heart surgery and open-heart surgery. Both procedures are performed under general anesthesia.

In an open-heart surgery, a large incision (approximately 25 cm long) is made along the middle of the breastbone, allowing the surgeon access to the heart. Tubes are inserted into the heart and major blood vessels, connected to a heart-lung bypass machine that takes over the heart's function. The medication stops the heart, enabling surgeons to remove the damaged aortic valve. The new valve is sewn in place, and controlled electric shocks restart the heart before being taken off the bypass machine. Surgeons then secure the breastbone with wires, and the chest wound is closed using dissolvable stitches. The operation usually lasts a few hours.

A minimally invasive heart surgery involves making two to four tiny incisions in the chest. The surgeon uses a special computer to control robotic arms that work through small incisions during the procedure. A computer screen displays a 3D image of the heart and aortic valve in the operating room. Depending on the case, this procedure may or may not require a heart-lung bypass machine.

Other surgical techniques for valve replacement include:

TAVI/TAVR (transcatheter aortic valve implantation/transcatheter aortic valve replacement): A minimally invasive approach that involves making a small incision in the groin or left chest. The replacement valve (usually a biological valve) is threaded through a catheter with a balloon at its tip to widen the valve opening. The new valve replaces the faulty aortic valve without needing open-heart surgery. This procedure does not require the use of a heart-lung bypass machine.

Ross Procedure: In some cases, surgeons use the patient's pulmonic valve to replace the damaged aortic valve. The pulmonic valve is then replaced with an artificial valve. Patients who do not want to take blood thinners for the rest of their lives can benefit from this procedure. However, the new aortic valve's lifespan is limited, and it may eventually need replacement (either with a mechanical or biological valve).

There are two primary types of replacement valves:

Mechanical Valves: These valves are made from artificial materials like stainless steel, titanium or ceramic. Mechanical valves are durable and can last a lifetime. However, patients with mechanical valves must take blood-thinning medications (such as warfarin or aspirin) indefinitely to prevent clotting for life.

Biological Valves: These valves are made from human or animal tissue. While they do not last as long as mechanical valves (typically 12 to 15 years), many patients with biological valves may not need lifelong blood thinners, making them a favorable choice for some patients.

Remember, the choice between these valve types depends on various factors, including a patient's age, overall health and lifestyle considerations. Patients should consult a healthcare provider to determine the best option for their condition.

What Are the Benefits of Aortic Valve Replacement Surgery?

For patients with mild aortic valve problem symptoms, regular echocardiograms are recommended, usually every one or two years, to help monitor whether the problem is progressing. However, for patients with severe symptoms, valve replacement surgery is highly recommended. Without treatment, conditions like aortic valve stenosis or aortic valve regurgitation worsen over time and can often lead to heart failure.

Research suggests that untreated severe aortic valve stenosis carries a 25% chance of death within the first year after symptoms appear, increasing to 50% in the second year. Similarly, severe aortic valve regurgitation has a 25% mortality risk after five years following the onset of symptoms, rising to 50% after ten years.

Timely intervention and close monitoring are crucial for managing aortic valve conditions. With proper treatment, most people enjoy improved health and quality of life.

What Are the Risks of Aortic Valve Replacement Surgery?

When it comes to surgeries, there are potential risks. Individuals who have undergone heart valve repair, replacement, or damage are particularly susceptible to infective endocarditis—an infection of the valve. Additionally, potential complications include excessive bleeding from chest tubes, blood clots associated with mechanical valve replacements, stroke or transient ischemic attacks (TIAs), valve deterioration for patients who have had biological heart replacement for a long time, arrhythmias and kidney issues. It is essential to note that older patients and those in overall poor health tend to face a higher risk of complications.

Find a Cardiovascular and Thoracic Surgeon in San Antonio

Heart care is a journey better taken together. When it comes to your heart health, finding the right partner in care is crucial. The cardiovascular and thoracic team at the Cardiovascular and Thoracic Surgical Institute of Texas, a member of Baptist Medical Network in San Antonio, combines experience and compassionate care to help you understand your risk or explore solutions to treat or manage symptoms if you already have a cardiovascular condition.

Whether you need heart surgery, lung procedures, or vascular interventions, let us help you walk the journey to better health together. To connect with our patient navigator, call 210-798-4311 or find a cardiovascular and thoracic surgeon here. Please don't delay care.

Takeaways

Heart valve disease is a condition not to be taken lightly. Initially, you might feel fine and remain unaware of any issues for years. However, once symptoms like angina (chest pain), syncope (fainting or sudden loss of consciousness) and dyspnea (breathing difficulty or discomfort) arise, life expectancy and quality of life can decline. Heart valve disease typically progresses. While those who receive no treatment face a poor outlook, many people who do seek treatment go on to lead vibrant, healthy lives, especially when their overall cardiovascular risks are low.