What it is
The aortic valve is located between the pumping chamber on the left side of the heart and the aorta, which is 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 to replace an aortic valve that doesn't open (stenosis) or close (regurgitation) properly. 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 or cow.
Reasons for Procedure
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 misshapen due to a birth defect. Other times, the aortic valve works well for years before becoming too stiff or too floppy to open and close fully. Sometimes this happens due to normal aging.
Possible Complications
If you are planning to have a valve replacement, your doctor will review a list of possible complications, which may include:
- Infections
- Bleeding
- Stroke
- Damage to other organs, such as the kidneys
- Irregular heart rhythm
- Death
Some factors that may increase the risk of complications with heart surgery include:
- Lung disease, especially chronic obstructive pulmonary disease (COPD) (emphysema)
- Prior heart attack or cardiac surgery
- Obesity
- Diabetes
- Smoking
- Kidney disease
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Chest X-ray
- Lab work
- Echocardiogram
- Electrocardiogram (ECG, EKG)
- Cardiac catheterization
Talk to your doctor about your medication. You may need to stop taking certain medication for one week before surgery, such as:
- Blood-thinning drugs, such as warfarin (Coumadin)
- Anti-platelet drugs, such as clopidogrel (Plavix)
- Diabetes medications, such as metformin (Glucophage)
Your doctor may also ask you to:
- Eat a light meal the night before. Do not eat or drink anything after midnight.
- Arrange for a ride to and from the hospital.
- Arrange for help at home after the procedure.
Anesthesia
General anesthesia will be given. You will be asleep during the procedure.
Description of Procedure
An incision will be made down the middle of your chest and the breastbone will be separated. A heart-lung machine will be attached, which allows the doctor to stop your heart to safely work on the heart valve.
Immediately After Procedure
You will be monitored in the intensive care unit, where you will have the following interventions:
- Heart monitor
- Pacing wires to control heart rate
- Tubes connected to a machine to drain fluids from the wound
- Breathing tube or an oxygen mask
- Catheter inserted into the bladder
How Long Will It Take?
The surgery can take anywhere from 3 to 6 hours.
How Much Will It Hurt?
Anesthesia prevents pain during surgery. You may be given medication for any pain during recovery. Pain levels vary from patient to patient.
Average Hospital Stay
The average stay is 3 to 6 days.
Post-procedure Care
At the Hospital
- To reduce the risk of fluid buildup in your lungs, you will be instructed to breathe deeply and cough 10 to 20 times every hour.
- Efforts will be made to get you out of bed and walking as soon as possible.
- Dressings will be removed in a day or two. Pacing wires and chest tubes will be removed within the first few days.
At Home
When you return home, do the following to help ensure a smooth recovery:
- Take medicines as directed by your doctor, such as:
- Antiarrhythmics
- Blood thinners (If you have a mechanical valve, you will have to take blood-thinning medicines for the rest of your life. This will help to prevent blood clots. If you have a tissue valve, you will need to take blood-thinning medicine for six weeks to three months after surgery)
- Cholesterol-lowering medicine
- Blood pressure medicine
- Pain medicine
- You may also need to take antibiotics during dental procedures and during certain other procedures as this will help prevent a valve infection
- Follow your doctor's guidelines for caring for your incisions
- Weigh yourself every morning
- Be sure to follow all of your doctor's instructions
Recovering after Surgery/What to Expect
Every patient’s recovery can be different. You will need to shower, daily, with a mild soap. Ask your doctor when it is safe to take a bath or soak in water. You may find that there will be some areas of discomfort in the area of surgery that can last for several weeks. Also, it is common that you may feel tired for many weeks following this type of surgery.
You will be asked not to do any type of heavy lifting for two months that will cause pain at the surgical site. People with jobs requiring strong physical activity may require additional time before resuming those types of activities. Be sure to ask your doctor when you can drive and return to work.
When to Call Your Surgeon:
- Pain that you cannot control with the medication you have been given
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
- Nausea and/or vomiting that you cannot control with the medication you were given after surgery or that lasts longer than expected
- Cough, shortness of breath, or chest pain
- Pain, burning, urgency, frequency of urination, or persistent blood in the urine
- Gaining more than four pounds within one or two days
- Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
In case of an emergency, call for medical help right away.
Meet with a doctor within 1 week
To learn more about how we can help you, contact us. We’ll return your call the same day and can secure you an appointment with one of our doctors within the week.
Call 617-789-2045 to request an appointment.