What is Aortic Valve Replacement Surgery?
Aortic valve replacement is an open-heart surgery technique through which damaged or diseased aortic valve is replaced with an artificial heart valve to treat problems associated with the aortic valve. When the heart valve opens, the blood flows through your heart into the aorta and on to the rest of your body. These heart valves help the blood to flow in the right direction through the heart. When the aortic valve closes, it restricts the blood to flow from the wrong direction back into your heart. This cycle recurs with every heartbeat. If the heart valve gets damaged, leaky or partially blocked your doctor may recommend having Heart Valve Replacement surgery. When the aortic valve isn’t functioning properly, it can obstruct blood flow as well as pressurize the heart to function properly to supply the crucial blood to the rest of your body. An aortic valve replacement procedure involves open-heart surgery via a sternotomy, minimally invasive cardiac surgery (MICS) and transcatheter aortic valve replacement (TAVR). It is considered a Complex operation and isn’t suitable for everyone and may take a longer time to recover. In exceptional cases, aortic valve disease may not have any warning signs or symptoms for many years. While others may experience breathlessness, weakness, chest pain, loss of consciousness, arrhythmia, heart attack, and sudden cardiac arrest. Aortic valve repair or aortic valve replacement can cure aortic valve infections or disease, and also retains natural blood flow, minimize the symptoms, and improve the heart functioning.
Symptoms of Aortic Valve Disease
There are many symptoms associated with aortic valve disease which may increase in severity as the disease progresses and can even be fatal if left untreated. However, Some patients suffering from aortic valve disease may not experience any symptoms even when the stenosis (narrowing) or insufficiency (leak) is severe.Here are the Common Signs and symptoms of aortic valve disease:
- Loss of consciousness
- Fainting during physical activity
- Chest pain or tightness
- Abnormal heartbeat (Arrhythmia)
- Tiredness after being active
- Swollen ankles and feet
Risks of Aortic Valve Replacement
An Aortic Valve replacement is considered to be a complex operation associated with the risks or complications, some of which can be life-threatening. If a patient with aortic stenosis and aortic regurgitation are not treated, they are at higher risk. However, the risk of experiencing complications is higher in older people than those in poor health.The Potential risks associated with heart valve treatment includes:
- Excessive Bleeding at the time, or after the surgery or any impairment to the blood vessels is a common risk associated with heart valve replacement. The doctor may insert Tubes into your chest to drain the blood, and in exceptional cases, another operation may be performed to prevent bleeding.
- Blood clots are likely to occur if you have undergone mechanical valve replacement.
- Heart attack or stroke is a common risk that occurs due to blood clotting.
- Infection at the incision site of heart valve surgery.
- Infection in the new valve (endocarditis), is common in valve replacement surgery. Your doctor may give you antibiotics to prevent the infection.
- Shortness of breath due to lung infection.
- Arrhythmia (abnormal heartbeat) may affect some people after an aortic valve replacement that usually get cured with time. However, in some cases, a pacemaker should be fitted to control their heartbeat.
- Valve failure may occur when the valve gets torn out over the years, or because of a heart infection.
- Kidney problems may occur in some cases when the kidney doesn’t function properly after the surgery and temporary dialysis may be required.
Aortic Valve Replacements Alternatives
An aortic valve replacement is the most compelling treatment for aortic valve diseases. The Alternate treatment options are usually recommended only for people who aren’t in good overall health for aortic valve replacement.
Aortic valve replacement Alternatives include:
Transcatheter Aortic Valve Implantation (TAVI)
The main advantage of this technique is that it puts less strain on the body as only a small incision is made in the chest that helps in quick recovery, minimal loss of blood and infection with high success rate. TAVI is only recommended for people who are too weak to have aortic valve replacement surgery.
Aortic valve balloon valvuloplasty
Aortic valve balloon valvuloplasty is recommended only to people who are not suitable for conventional open surgery. This procedure is a short-term treatment usually performed on babies and children until they’re old enough for valve replacement. The main disadvantage of this procedure is that the treatment effects only last up to a year and further treatment is required.
Sutureless aortic valve replacement
Sutureless aortic valve replacement is the latest alternative to open-heart surgery. The main difference between the two procedures is that there are no stitches involved in the sutureless procedure to secure the replacement valve in place. This procedure reduces operation time, so there is less time spent on a bypass machine. This option is suitable for people who are at high risk of complications during the standard procedure.
The main risks of this treatment are blood leakage or blood clot formation around the replacement valve area that increases the chance of having a stroke in a patient. A leakage may mean that there is an issue for which the procedure needs to be performed again to fix the problem, or an alternative treatment may be needed.
Preparing for aortic valve surgery
A few weeks before the procedure, the patient needs to visit the hospital for a pre-admission assessment to check whether the operation is suitable. The assessment involves a physical examination, the doctor may ask you about your medical history, allergies, and medications that you are taking. The general heart health tests including blood tests, X-ray, ECG, an echocardiogram will be done to ensure if you are healthy to undergo surgery.
Your doctor will also explain to you what to expect before, during and after the procedure and the potential risk involved in it. If you smoke, the doctor may advise you to quit smoking as it lowers the risks of complications occurring after the surgery, such as chest infection or blood clots. This is also a good time to ask any queries about the aortic valve replacement procedure. When you undergo the operation, you are likely to stay in a hospital for at least a week, so you’ll need to make some practical arrangements including bringing clothes, toiletries and any other equipment you use, such as hearing aid and walking stick.
During Aortic Heart Valve Surgery
An aortic valve repair and aortic valve replacement surgery are carried out under anesthetics. This means the patient will be unconscious during the surgery and this is done to ensure that the patient doesn’t feel any pain while undergoing the procedure which may usually take 2-4 hours.
The Patient will be connected to a (heart-lung) bypass machine, which ensures blood moves through your body during the surgery.
- During the procedure, a large incision is made in the center of your breastbone to enable the surgeon to access your heart, although in some cases a smaller incision may be made.
- Tubes will be inserted into your heart and large blood vessels, which are attached to a (heart-lung) bypass machine which will control the heart activity during the operation and also be diverting your blood into the machine instead of your heart. The machine will be pumping oxygen-rich blood to the body until the operation is done, taking over the role of your heart and lungs.
- Medication is used to stop your heart and the main artery is clamped closed which enables the surgeon to open the heart and perform the operation without blood pumping through it.
- The surgeon will restart your heart using regulated electric shocks, before taking you off the bypass machine.
- The Aorta is opened up, and a damaged or faulty valve is replaced with the new heart valve and your breastbone will be sewn in place with a thin wire, and the chest wound will be shut using dissolvable stitches.
- Tubes will be inserted into small holes in your chest (called chest drains) to drain away any blood or fluid that builds up.
Aortic Heart Valve Surgery Recovery
After aortic valve replacement surgery, you are likely to spend a day or more in the intensive care unit (ICU) depending on your condition and procedure and later you will be moved to a regular ward for about a week.
You’ll be given fluids, oxygen, nutrition, and medications through intravenous (IV) lines. Other tubes will be used to drain urine from your bladder and drain fluid and blood from your chest.
During your stay in the hospital, your doctor will look for signs of infection in your incision sites, will also be periodically checking your blood pressure, breathing and heart rate, and will also work with you to manage any pain you experience after surgery. The patient will be advised to take rest and limit their activities initially. However, at a later stage doctor may suggest you walk & start breathing exercise regularly, or join a cardiac rehabilitation program when you are recovering.
The recovery time may vary depending on a patient’s age, type of surgery and overall health before surgery.
Your breastbone will usually take about 6 to 8 weeks to heal, however, it may take 2 to 3 months before you get back to your normal self again.
Aortic Valve Repair or Replacement
The decision to replace or repair a damaged aortic valve is made depending on many factors including:
- The severity of aortic valve condition
- Patient’s age and overall health before surgery
- Structure of the heart
- Results of your diagnostic tests
- Whether a patient needs heart surgery to correct another heart problem in addition to aortic valve disease. If so, both heart problems can be treated at once.
If you have a faulty or damaged heart valve, your doctor may suggest you have Aortic valve repair surgery. Generally, heart valve repair is usually more recommended as compared to valve replacement because of the lower infection risk, retains valve strength and function, and minimizes the need for blood-thinning medications for the rest of your life.
The Aortic valve replacement surgery is mostly performed If the aortic valve is no longer working properly, surgery may be required to replace it. However, the best option may depend on an individual situation as well as the expertise and experience of the heart team.