Aortic Valve Replacement
The aortic valve is between the pumping chamber on the left side of the heart and the aorta. The aorta is a major artery that 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 let blood flow.
Aortic valve replacement is an open-heart surgery. It is done to replace a failing aortic valve with a new one. The replacement valve may be:
- Mechanical—It is man made.
- Bioprosthetic—This valve is made out of a blend of man made materials and tissues from a pig, cow, or other animal.
- Homograft or allograft—The valve is from a donated human heart.
- Ross procedure—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 place 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.
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Reasons for Procedure
Aortic valve replacement is done when the aortic valve is not working properly. The amount of oxygen-rich blood getting to the body can be greatly decreased with a faulty valve.
Sometimes, the aortic valve is misshapen due to a problem that was there at birth. 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 not work as well. The valve problem may also happen due to other health issues such as:
- Rheumatic valve disease—a problem due to streptococcal throat infection, which can harm 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 because there is an aortic aneurysm
Problems are rare, but all procedures have some risk. The doctor will go over things that could happens, such as:
- Irregular heart beat
- Blood clot forms and causes a stroke or kidney damage
- New valve does not work well
- Complications from anesthesia
Talk to your doctor about ways to manage things that may raise your risk of problems, such as:
Your risk of problems may also be higher if you have:
- Other heart conditions
- Lung conditions
What to Expect
Problems To Look Out For
Call the doctor if you have:
- Signs of infection, including fever or chills
- Redness, swelling, more pain, a lot of bleeding, or any discharge from the incision site
- Shortness of breath, lightheadedness, or fainting
- Cough or chest pain
- Lasting nausea or vomiting
- Pain that you cannot control with the medicines you were given
- Problems urinating, or pain, burning, frequency, urgency, or bleeding with urination
- Pain or swelling in your feet, calves, or legs
If you think you have an emergency, call for medical help right away.
Prior to Procedure
Your doctor will likely do some tests:
- Echocardiogram—This is a test that uses sound waves to make a moving picture of your heart and its valves.
- ECG—This is a test of the electrical system of your heart.
- Cardiac catheterization—For this test, a very thin tube is threaded through your aorta. Contrast dye is squirted through the catheter and x-ray images are captured. These images can reveal problems with how your aortic valve is working and also see if 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 medicine up to 1 week before the procedure.
- Do not eat or drink anything after midnight the night before your surgery, unless told otherwise by your doctor.
- Ask someone to help you at home after you get out of the hospital.
- Have someone ready to drive you home when you leave the hospital.
- Aortic valve replacement. NHS website. Available at: https://www.nhs.uk/conditions/aortic-valve-replacement.
- Aortic valve surgery. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/16745-aortic-valve-surgery.
- Prosthetic heart valves. EBSCO DynaMed website. Available at: https://www.dynamed.com/procedure/prosthetic-heart-valves.
- Valve repair or replacement. Texas Heart Institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/valve-repair-or-replacement.
- Michael J. Fucci, DO, FACC
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