Aortic valve repair and aortic valve replacement are procedures that treat diseases affecting the aortic valve, one of four valves that control blood flow through the heart.
The aortic valve helps keep blood flowing in the correct direction through the heart. It separates the heart’s main pumping chamber (left ventricle) and the main artery that supplies oxygen-rich blood to your body (aorta).
With each contraction of the ventricle, the aortic valve opens and allows blood to flow from the left ventricle into the aorta. When the ventricle relaxes, the aortic valve closes to prevent blood from flowing backward into the ventricle.
When the aortic valve isn’t working properly, it can interfere with blood flow and force the heart to work harder to send blood to the rest of your body.
Aortic valve repair or aortic valve replacement can treat aortic valve disease and help restore normal blood flow, reduce symptoms, prolong life and help preserve the function of your heart muscle
What is aortic valve disease?
Aortic valve disease occurs when the aortic valve does not work correctly. This can be caused by:
Aortic valve stenosis: These stiff, fused, thickened, inflexible valve leaflets lead to the narrowing of the aortic valve, which limits the blood flow. Aortic valve stenosis progresses when calcium is deposited on the valve leaflets, further limiting their mobility. Stenosis can occur in patients with either a tricuspid (3 leaflets) or a bicuspid (2 leaflets) aortic valve.
Aortic valve regurgitation (also called valvular insufficiency, incompetence or “leaky valve”): These valve leaflets do not close completely. Regurgitation causes the blood that is ejected by the heart to immediately flow back into the heart once the heart stops squeezing and relaxes. Regurgitation may occur because of floppy leaflets (prolapse), abnormal congenitally deformed valves (bicuspid or unicuspid), infection of the valve (endocarditis), the inability of the leaflets to close tightly due to dilatation of the aorta (aneurysm), holes in the leaflets, or rheumatic valve disease.
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 temporarily with a less invasive procedure called balloon valvuloplasty — which uses an approach called cardiac catheterization. You’re usually awake during cardiac catheterization.
During balloon valvuloplasty, your doctor inserts a thin, hollow tube (catheter) in a blood vessel, usually in your groin, and threads it to your heart. The catheter has a balloon at its tip that can be inflated to help stretch the narrowed aortic valve and then deflated for removal.
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.
Some replacement heart valves may begin to leak or not work as well over time. These issues can be fixed using surgery or 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 (valve). Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.
Often, biological tissue valves eventually need to be replaced because 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. 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).
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.
What Are the Risks?
Most people do well with this surgery. Like any operation, though, it can lead to problems, including:
- Bleeding after surgery
- Blood clots
- Heart rhythm gets thrown off for a while
- Kidney problems that may last for a few days after surgery
- New valve doesn’t work or wears out over time
Call your doctor if you notice any of these signs during your recovery:
- Fever of 100.4 F or higher
- Pain, redness, or swelling around the wound gets worse
- Pus or other fluid coming from the wound
- Shortness of breath that gets worse
- Symptoms you had before surgery, like chest pain or dizziness, come back