Surgical Procedure

o Aortic valve surgery - minimally invasive

Blood flows out of your heart and into a large blood vessel called the aorta. The
aortic valve separates the heart and aorta. The aortic valve opens so blood can flow out. It
then closes to keep blood from returning to the heart.
You may need aortic valve surgery to replace the aortic valve in your heart if:
o aortic regurgitation
o aortic stenosis
The aortic valve can be replaced using:
o Minimally invasive aortic valve surgery, done using one or more
small cuts
o Open aortic valve surgery, done by making a large cut in your chest

Before your surgery you will receive general anesthesia.

You will be asleep and pain-free.
There are several ways to do minimally invasive aortic valve surgery. Techniques include
min-thoracotomy, min-sternotomy, robot-assisted surgery, and percutaneous surgery. To
perform the different procedures:
o

Your surgeon may make a 2-inch to 3-inch cut in the right part of

your chest near the sternum (breastbone). The muscles in the area
will be divided. This lets the surgeon reach the heart and aortic
valve.
Your surgeon may split only the upper portion of your breast bone

allowing exposure to the aortic valve.

For robotically-assisted valve surgery, the surgeon makes 2 to 4
tiny cuts in your chest. The surgeon uses a special computer to
control robotic arms during the surgery. A 3D view of the heart and
aortic valve are displayed on a computer in the operating room.

You may need to be on a heart-lung machine for all of these surgeries.

When the aortic valve is too damaged for repair, a new valve is put in place. Your surgeon will
remove your aortic valve and sew a new one into place. There are two main types of new valves:
o

Mechanical, made of man-made materials, such as titanium or

carbon. These valves last the longest. You will need to take bloodthinning medicine, such as warfarin (Coumadin), for the rest of your
life if you have this type of valve.

Biological, made of human or animal tissue. These valves last 10

to 20 years, but you may not need to take blood thinners for life.

Transcatheter aortic valve replacement (TAVR).

TAVR aortic valve surgery can be done through a small incision made in the
groin or the left chest. The replacement valve is passed into the blood vessel or the
heart and moved up to the aortic valve. The catheter has a balloon on the end. The
balloon is inflated to stretch the opening of the valve. This procedure is called
percutaneous valvuloplasty and allows for a new valve to be placed in this spot. The surgeon then
sends a catheter with an attached valve and detaches the valve to take the place of the damaged
aortic valve. A biological valve is used for TAVR. You do not need to be on a heart-lung machine for
this procedure.

Coronary artery bypass surgery (CABG)

surgery to replace part of the aorta at the same time.

Once
o
o
o
o

the new valve is working, your surgeon will:

Close the small cut to your heart or aorta
Place catheters (flexible tubes) around your heart to drain fluids that build up
Close the surgical cut in your muscles and skin
The surgery can take 3 to 6 hours, however a TAVR procedure is often shorter.

Why the Procedure is Performed?

Aortic valve surgery is done when the valve does not work properly. Surgery
may be done for these reasons:
o Changes in your aortic valve are causing major heart symptoms, such as
chest pain, shortness of breath, fainting spells, or heart failure.
o Tests show that changes in your aortic valve are harming the work of your
heart.
o Damage to your heart valve from infection (endocarditis)
o A minimally invasive procedure can have many benefits. There is less pain,
blood loss, and risk of infection. You will also recover faster than you would
from open heart surgery.

Percutaneous valvuloplasty and Transcatheter-based valve

replacement (TAVR) are done only in people who are too sick or at very
high risk for major heart surgery. The results of percutaneous valvuloplasty
are not long-lasting.

Risks
Risks
o
o
o

for any anesthesia are:

Bleeding
Blood clots in the legs that may travel to the lungs
Breathing problems

o
o
Other
o
o
o
o
o
o

Infection, including in the lungs, kidneys, bladder, chest, or heart valves

Reactions to medicines
risks vary by the person's age. Some of these risks are:
Damage to other organs, nerves, or bones
Heart attack, stroke, or death
Infection of the new valve
Kidney failure
Irregular heartbeat that must be treated with medicines or a pacemaker
Poor healing of incision

Before the Procedure

Always tell your health care provider:
o If you are or could be pregnant
o What medicines you are taking, even drugs, supplements, or herbs you
bought without a prescription
o You may be able to store blood in the blood bank for transfusions during and
after your surgery. Ask your provider about how you and your family
members can donate blood.
o For the week before surgery, you may be asked to stop taking medicines that
make it harder for your blood to clot. These might cause increased bleeding
during the surgery.
o Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve,
Naprosyn).
o If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your
surgeon before stopping or changing how you take these drugs.
o During the days before your surgery:
o Ask which medicines you should still take on the day of your surgery.
o If you smoke, you must stop. Ask your provider for help.
o Always let your provider know if you have a cold, flu, fever, herpes breakout,
or any other illness in the time leading up to your surgery.

Prepare your house for when you get home from the hospital.
Shower and wash your hair the day before surgery. You may need to wash
your body below your neck with a special soap. Scrub your chest 2 or 3 times
with this soap. You also may be asked to take an antibiotic to prevent
infection.
On the day of your surgery:

You may be asked not to drink or eat anything after midnight the night before
your surgery. This includes using chewing gum and mints. Rinse your mouth with
water if it feels dry. Be careful not to swallow.

Take the medicines you have been told to take with a small sip of water.

You will be told when to arrive at the hospital.

After the Procedure

After your operation, you will spend 3 to 7 days in the hospital. You will spend
the first night in an intensive care unit (ICU). Nurses will monitor your
condition at all times.
Most of the time, you will be moved to a regular room or a transitional care
unit in the hospital within 24 hours. You will start activity slowly. You may
begin a program to make your heart and body stronger.
You may have two or three tubes in your chest to drain fluid from around
your heart. Most of the time, these are taken out 1 to 3 days after surgery.
You may have a catheter (flexible tube) in your bladder to drain urine. You
may also have intravenous (IV) lines for fluids. Nurses will closely watch
monitors that display your vital signs (pulse, temperature, and breathing).
You will have daily blood tests and EKGs to test your heart function until you
are well enough to go home.
A temporary pacemaker may be placed in your heart if your heart rhythm
becomes too slow after surgery.
Once you are home, recovery takes time. Take it easy, and be patient with
yourself.

Outlook (Prognosis)
Mechanical heart valves do not fail often. However, blood clots can develop
on them. If a blood clot forms, you may have a stroke. Bleeding can occur,
but this is rare.
Biological valves have a lower risk of blood clots, but tend to fail over time.
Minimally invasive heart valve surgery has improved in recent years. These
techniques are safe for most people and can reduce recovery time and pain.
For best results, choose to have your aortic valve surgery at a center that
does many of these procedures.