What you can expect
During the procedure
For most aortic valve repair and aortic valve replacement procedures, you'll receive anesthetics so you won't feel any pain, and you'll be unconscious during the surgery.
You'll also be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Aortic valve repair
Aortic valve repair is usually performed through traditional open-heart surgery and opening of the chest bone (sternotomy). Doctors wire the bone back together after the procedure to prevent movement and aid in healing.
Aortic valve repair procedures may involve several different types of repair, including:
- Inserting tissue to patch holes or tears in the flaps (perforated cusps) that close off the valve
- Adding support at the base or roots of the valve
- Separating fused valve cusps
- Reshaping or removing tissue to allow the valve to close more tightly
- Tightening or reinforcing the ring around a valve (annulus) by implanting an artificial ring (annuloplasty)
Aortic valves that can't open fully due to aortic valve stenosis may be repaired with surgery or with a less invasive procedure called balloon valvuloplasty — which uses an approach called cardiac catheterization. You're usually awake during cardiac catheterization, and it requires a much shorter hospital stay than traditional heart surgery.
Balloon valvuloplasty is often used to treat infants and children with aortic valve stenosis. However, the valve tends to narrow again in adults who have had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement. You may need additional procedures to treat the narrowed valve over time.
Doctors may also use a catheter procedure to perform aortic valve repair by inserting a plug or device to fix a leaking replacement heart valve.
Aortic valve replacement
In this procedure, your doctor removes the aortic valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue. Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.
Often biological tissue valves often eventually need to be replaced, as they degenerate over time. If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots. Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you.
Aortic valve replacement surgery may be performed through traditional open-heart surgery or minimally invasive methods, which involve smaller incisions than those used in open-heart surgery.
But minimally invasive aortic valve replacement is less common because not all situations are best addressed by this method of access to the damaged valve. When performed by experienced surgeons and centers, the results are similar to those with traditional open-heart surgery.
Transcatheter aortic valve replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is another type of minimally invasive aortic valve replacement that has a nonsurgical approach. It is also sometimes called transcatheter aortic valve implantation (TAVI).
During TAVR, your doctors may access your heart through a blood vessel in your leg or a small incision in the chest. A hollow tube (catheter) is guided through your veins to the aortic valve. Once it is positioned correctly, a balloon-expandable or self-expandable replacement aortic valve is inserted.
TAVR may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement.
TAVR may also be an option if you have an existing biological tissue valve that was previously inserted to replace the aortic valve, but it isn't functioning well anymore.
After the procedure
You'll generally spend a day or more in the intensive care unit (ICU). You'll be given oxygen, fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your chest.
After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure.
During your hospital stay, your treatment team will likely:
- Watch for signs of infection in your incision sites
- Periodically check your blood pressure, breathing and heart rate
- Work with you to manage any pain you experience after surgery
- Instruct you to walk regularly to gradually increase your activity and do breathing exercises as you recover
Your doctor may give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.
Recovery time depends on your procedure, overall health before the procedure and any complications.
Your doctor may advise you to avoid driving a car or lifting anything more than 10 pounds for several weeks. Your doctor will discuss with you when you can return to normal activities.