Aortic valve replacement

Aortic valve replacement – 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 — It is made entirely out of artificial materials.
• Bioprosthetic — This valve is made out of a combination of artificial materials and tissues from a pig, cow, or other animal.
• Homograft or allograft — The valve is 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.

Aortic valve replacement – Reasons for Procedure

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 to the rest of 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.

Aortic valve replacement is done 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 misshaped due to a birth defect. This is called congenital aortic valve disease. Other times, the aortic valve works 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 valve causes it 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 aorta
• Aortic dissection — bleeding into the wall of the aorta, usually due to the presence of an aortic aneurysm
• Aortic valve stenosis — valve is too stiff to open fully; heart may have a hard time pumping blood into the aorta
• Aortic valve regurgitation — valve does not close fully; allows blood flow from the aorta to leak through the valve back into the heart

Aortic valve replacement – Possible Complications

If you are planning to have a valve replacement, your doctor will review a list of possible complications, which may include:

• Infection
• Bleeding
• Irregular heart beats
• Scarring
• Blood clot formation resulting in a stroke or kidney damage
• Valve does not function correctly
• Complications from anesthesia

Some factors that may increase the risk of complications include:

• Other heart conditions
• Lung conditions
• Chronic illness, including high blood pressure and diabetes
• Elderly age
• Infections
• Smoking
• Obesity

Aortic valve replacement – What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Blood tests
• Echocardiogram — This is a test that uses sound waves to produce a moving picture of your heart and its valves.
• Electrocardiogram — This is a test of the electrical system of your heart.
• Cardiac catheterization — For this test, a very thin tube is threaded up through your aorta. Contrast dye is squirted through the catheter, and x-ray images are captured. These images can reveal problems with the functioning of your aortic valve and also determine whether your heart arteries are free from disease.

Leading up to your procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
• 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.

Aortic valve replacement – Anesthesia

Aortic valve replacement is done with general anesthesia. You will be asleep.

Aortic valve replacement – Description of the Procedure

An incision will be made down the middle of your chest. The breastbone will be separated so that your heart can be reached. A heart-lung machine will be attached. The machine will act as your heart and lungs. This allows the doctor to stop your heart to safely work on the heart valve.

An incision will be made in the aorta. The damaged valve will be cut out and a new valve will be sewn into place. The aorta will then be sewn back together. The heart will be started up again and the heart-lung machine will be removed. The breastbone will be wired together. The skin incision in the chest will be sewn back together.

Aortic valve replacement – After the Procedure

You will be monitored in an intensive care unit directly after surgery. When you awaken, you will 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 to drain your stomach of excess fluid and gas
• A catheter in your bladder to drain urine
• An IV line to provide fluids, electrolytes, and pain medicines directly into a vein

Aortic valve replacement – How Long Will It Take?

About 2-4 hours

Aortic valve replacement – How Much Will It Hurt?

Anesthesia will block pain during the surgery. The incision in the chest and breastbone will cause pain after the surgery. You will be given pain medicine to help manage the pain.

Aortic valve replacement – Average Hospital Stay

The usual length of stay is 5-7 days. The length of stay will depend on your overall health and your recovery progress. Your doctor may choose to keep you longer if complications arise.

Aortic valve replacement – Postoperative Care

At the Hospital

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. You will be allowed to walk soon after your surgery.

You may be given a device called an incentive spirometer. You will be asked to use it every couple of hours during the day. This helps keep your lungs as open as possible. This can help you avoid pneumonia.

At Home

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.

• If you have a mechanical valve, you will have to take blood-thinning medicines (anticoagulants) for the rest of your life. They are needed to keep clots from forming around the valve.
• Depending on the type of valve you have, you will need to take an antibiotic whenever you have dental procedures or certain surgical procedures.
• You may be referred to cardiac rehabilitation. This can help you regain normal functioning and reduce the chance of future problems.
• Be sure to follow your doctor’s instructions.

Aortic valve replacement – Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
• Shortness of breath, dizziness, or fainting
• Cough or chest pain
• Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
• Pain that you cannot control with the medicines you have been given
• Difficulty urinating, or pain, burning, frequency, urgency, or bleeding with urination
• Pain or swelling in your feet, calves, or legs

In case of an emergency, call for medical help right away.