What is Aortic Valve Replacement?

The critical function of the Aortic valve is to pump the blood and keep it flowing to the rest of the body in the right direction. The aortic valve functions as a separation between the heart's left ventricle and the aorta, and it supplies oxygenated blood throughout the body. Each contraction of the heart opens up the aortic valve, allowing blood to flow through, and once it relaxes, the aortic valve closes and prevents any blood from seeping back into the ventricle. Any kind of malfunction in the valve mechanism can cause the heart to expend more effort pumping blood to the entire body. It can cause strain on the heart, especially if it persists for a prolonged period.

Aortic Valve Replacement

Why is Aortic Valve Replacement Performed?

An Aortic valve repair or replacement is performed if the patient suffers from Aortic valve disease that hampers the valve's functioning and impairs blood flow from the heart to the rest of the body. The diagnosis and treatment depend on the condition and the level of impairment to the valve function.

Conditions That Require Aortic Valve Replacement

Congenital Heart Disease:

In some instances, congenital heart defects (Defects from birth) may lead to a condition called aortic valve regurgitation. It is where the valve doesn't function properly, and the blood flows back into the ventricle. There may be conditions, such as the valve being too small, too large, or even the wrong shape, that affect the blood flow, called atresia. In minor cases that don't exhibit symptoms, it can be treated with supervision; however, since aortic valve disease often progressively gets worse with time, it may require surgical intervention. Without timely intervention, there is a high risk of complications such as heart attack, sudden cardiac arrest, or heart failure.

Aortic Valve Regurgitation:

If the aortic valve's functioning is impaired, blood that is supposed to flow from the ventricle to the aorta may seep back into the ventricle. This could be attributed to a dysfunctional or leaky valve, a misshapen valve (Congenital Defect), or a bacterial infection that weakens the valve.

Aortic Valve Stenosis:

Stenosis occurs when the heart's ability to pump blood becomes harder because the aortic valve is too narrow or obstructed. It may occur due to congenital heart disease, rheumatic heart disease, or the thickening of the aortic valve flaps, which can cause it to malfunction.

Types of Aortic Valve Replacement

Mechanical Valve Replacement:

A mechanical man-made valve made of strong, durable materials replaces the natural valve. Mechanical heart valves are usually designed as bi-leaflets, which means that they have two leaflets that act as a 'unidirectional mechanism' that ensures the blood flows the right way from the ventricle to the aorta without any chance of backflow.

Ross Procedure:

It is usually carried out in younger patients. In this procedure, a patient's pulmonary valve is used to replace the damaged aortic valve, and this is called an autograft. Later, the autograft is replaced by a pulmonary valve from a human donor, and this is called a homograft. The advantage of the procedure is that valves are replaced in such a way that they are shown to grow with the body if implanted during childhood.

Tissue Valve (Either animal or human donors)/ Bioprosthetic Aortic Valve Replacement:

Tissue valves may be harvested from a cow, in which case it's called a Bovine Aortic Valve Replacement, or from the heart of a pig, in which case it's called a Porcine Aortic Valve Replacement. These tissues undergo a medical procedure to ensure that the body does not reject them. The advantage of this procedure is that it reduces the need for blood thinners to be used in the long term.

TAVI/TAVR procedure (Transcatheter Aortic Valve Replacement):

Transcatheter aortic valve implantation is a procedure in which aortic valve stenosis is treated minimally invasively. In this procedure, a catheter is inserted through the femoral artery up to the aortic valve. They may also access the valve through an incision in the chest wall and through the apex of the heart. A replacement valve is deployed in place of the old one to restore blood flow and function.

Are you the right candidate for this procedure?

The kind of procedure, Aortic Valve Repair or Replacement, depends largely on the severity of the symptoms you experience. Your age, overall health, and other heart conditions or complications all factor into the chosen course of treatment.

Heart valve repair is usually preferred if the condition is not too severe. There is a lower risk of the body rejecting the treatment and a reduced risk of infection. It also reduces the need for blood-thinning medications after a heart valve replacement. Before suggesting either treatment, the doctor will thoroughly diagnose your heart condition and function.

These procedures can be conducted through open-heart surgery or minimally invasive methods. Minimally invasive methods are generally preferred as they involve a lower risk of complications, less scarring, less pain, and a faster recovery than a traditional procedure.

How Do I Prepare for the Procedure?

Your medical team will take special care to inform you of all the risks and complications associated with the surgery. You must ask the team any questions or concerns you may have with the procedure,

Here are some of the questions you must ask your doctor before the procedure:

Will your medication regimen need to be altered or changed before or after the procedure?
What are the dietary recommendations before or after the procedure?
What kind of physical activity is restricted before or after the procedure?
How long will it take to recover completely?
What will be the expenses for the procedure and the hospital stay?

Complications and Risks that May Arise due to Surgery

The procedure's risks greatly depend on your bill of health before the procedure is conducted, as well as the experience and expertise of your medical team. Hence, it would help if you did adequate research on the team involved in performing your surgery and the infrastructure available at the medical centre. It also helps to enquire about the number of similar procedures the team has undertaken and the success rate of the procedure at the centre.

Some of the risks associated with the procedure include:

Clotting of blood
Excessive bleeding
Dysfunction of replaced valves
Arrhythmia (Problems with the rhythm of the heart)
Stroke
Infections
Death

Understanding The Procedure

1. Aortic Valve Replacement

Aortic Valve Repair

This procedure entails the doctor surgically removing your malfunctioning heart valve and replacing it with a functional valve; this can either be mechanical or bioprosthetic from animals (Cows or Pigs) or humans. It's also possible that your pulmonary valve tissue is used in an autograft, also known as the Ross procedure.

When biological tissue is used, the valve may wear out over time and need to be replaced. However, if you choose a mechanical valve, you will have to use blood-thinning medications throughout your life to prevent the likelihood of blood clotting.

The doctor will explain all the pros and cons and the best treatment for your particular condition. You must consider your lifestyle, adherence to medication regimens, age, and level of activity when deciding which procedure to opt for. Your medical team will explain the most suitable procedure for you and the available options.

2. Aortic Valve Repair

In Aortic valve repair, the medical team usually performs open-heart surgery and inserts tissue to patch malformations in the aortic valve. It may also involve adding tissues to the base of the valve to ensure that the blood does not flow back into the ventricle. Other repairs include separating fused valve flaps and tightening the muscles around the valve.

In children suffering from aortic valve stenosis, repairs are usually done with less invasive procedures such as balloon valvuloplasty, in which a catheter is inserted into the heart, the valve is opened up, and then a mechanical or tissue valve is used to replace the faulty aortic valve.

However, in such a procedure, the valve may narrow down again, which may require other treatment procedures.

Road To Recovery

An Aortic valve repair is a complex medical procedure, so you must take certain medications and attend regular follow-up appointments to ensure a full recovery. Depending on the kind of transplant, you may need blood thinners to avoid blood clots being formed. You can eventually return to your daily physical activity and work schedule.

The doctor will also recommend changes to your lifestyle, such as a heart-healthy diet, quitting smoking, and stress management to avoid any complications that may arise.

Your doctor may also prescribe cardiac rehabilitation to expedite your recovery from the procedure. Cardiac rehab is a medically supervised program that involves counselling and training for heart-healthy exercises, information about lifestyle changes and risks, and ways to successfully manage stress in daily life. Adherence to Cardiac rehab will help you improve your cardiovascular health in the long term and reduce the chances of a heart attack, heart failure, or any complications with the aortic valve in the future.

Precautions To Take

Follow your doctor's recommendations religiously and adhere to medications prescribed
Good nutrition can speed your recovery, so follow a heart-healthy diet.
Meal planning can help you from falling off the wagon.
Ensure that you pace yourself during recovery and work up to your earlier activity level.
Before undertaking any strenuous physical activity, make sure you check with your doctor.
Include moderate physical activity of at least 150 minutes a week after checking with your physician.

Frequently Asked Questions Aortic Valve Replacement

Q1. What is Aortic Valve Replacement?
A1. The valves responsible for blood flow through the heart chambers are sometimes blocked and can't perform the task well. The aortic valve on the left side of the heart is responsible for the blood outflow. If this aortic valve has a congenital disability, it causes stenosis or regurgitation. Surgery helps to replace this valve for better functioning.

Q2. What is the success rate of aortic valve replacement surgery?
A2. Heart valvuloplasty and valve replacement have very high success rates in elderly patients. However, the prognosis can only be improved by optimising preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment.

Q3. How dangerous is heart valve replacement surgery?
A3. More than 95 per cent of people who undergo coronary bypass surgery do not experience serious complications. The risk of death immediately after the procedure is only 1 or 2 per cent.

Q4. How long does an aortic valve replacement take?
A4. Depending on the number of valves that need to be repaired or replaced, the surgery can take 2 to 4 hours or more. The patient is expected to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU).

Q5. Is heart valve replacement a major surgery?
A5. Heart valve replacement surgery and procedures are performed to repair or replace a heart valve that is malfunctioning because of valvular heart disease. It is a significant operation as it is an open-heart surgery through the breastbone into the chest.

Q6. Can the aortic valve be replaced without open-heart surgery?
A6. Until recently, open-heart surgery was the only option for replacing the valve. However, transcatheter aortic valve replacement, or TAVR, offers a less invasive alternative with an easier, shorter recovery.

Q7. Which heart valve is the most difficult to replace?
A7. The human heart has four valves: the Aortic valve, the Mitral valve, the Tricuspid valve, and the Pulmonic valve. Aortic valve replacement is the most common procedure and is not dangerous. The mitral valve is repaired chiefly when needed. Only the tricuspid or pulmonic valve is rarely repaired or replaced.

Q8. Does the rib cage need to be opened up for open-heart surgery?
A8. In open-heart surgeries, the surgeon will make a 6- to 8-inch incision (cut) right in the middle of your chest wall. The surgeon will cut the breastbone and open the rib cage to reach your heart. All significant precautions are taken in the process. The patient will be given medication to thin out the blood and to keep it from clotting. A breathing tube connected to the ventilator will be placed in the lungs through the throat.

Q9. What is the average age for heart valve replacement?
A9. Average patient age for a heart valve replacement is 53 to 92 years.

Q10. What is the most common kind of heart valve replacement?
A10. Aortic valve replacement is the most common surgical procedure for aortic stenosis or narrowing of the aortic valve. Aortic regurgitation is another common valve problem that requires valve replacement. Regurgitation is a condition where the valve allows blood to return to the heart instead of flowing out, which might cause heart failure. Mitral stenosis is another condition that sometimes requires a valve replacement procedure.

Q11. What is the life expectancy after undergoing a procedure that involves an Aortic Valve Replacement?
A11. The life expectancy depends entirely on the severity of the disease before the procedure. It also depends on various factors such as age, bill of health, sex, ethnicity and lifestyle. In a study conducted in the UK on the long term outcomes after Aortic Valve Replacement, survival rates ranged from 16 years for people aged 75. However, the process may need monitoring through regular intervals as bioprosthetic valves are likely to wear out and need replacement.

Q12. How dangerous is Aortic Valve Replacement?
A12. The safety of the procedure will depend on the expertise of your medical team with the procedure. However, complications could include excessive bleeding, stroke, heart attack and rejection of the valve by the body.

Q13. Can Aortic valve be replaced without open-heart surgery?
A13. Earlier, the aortic valves were usually replaced using open heart procedures. However, innovative procedures such as TAVR (transcatheter Aortic Valve Replacement) can be done via a small incision.

Q14. What are the symptoms of aortic valve problems?
A14. In some cases, aortic valve issues may not show any external symptoms; however, in case they do exhibit it may include:

Q15. What is the most common complication of Aortic Valve Replacement?
A15. Heart attack, stroke or chest wound infection has been reported in the case of open-heart surgery.

Q16. What are the changes I should make to my diet?
A16. After Aortic Valve Replacement, your physician will advise you to strictly avoid foods high in sugar and sodium. It includes processed foods and baked goods that might contain artificial preservatives.

Q17. What is the best kind of valve replacement?
A17. There are two valve replacements: Mechanical and Biological/Bioprosthetic, which can be from human or animal donors. Each has its own pros and cons, and your doctor will help you decide which is the best one for you.