Aortic valve replacement surgery

Aortic valve replacement gives you a new aortic heart valve. The new valve may be mechanical or made of animal tissue. You and your doctor can decide before surgery which type of valve is best for you.

The aortic valve opens and closes to keep blood flowing in the proper direction through your heart. When the aortic valve does not close properly, it's called aortic valve regurgitation. If the valve is very tight and narrow, it's called aortic valve stenosis. In both of these cases, blood does not flow through the heart the right way.

You will be asleep during the surgery. In an open-chest surgery, your doctor will make a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart. In a less invasive surgery, your doctor will make a cut between your ribs. Your sternum is not cut.

The doctor will connect you to a heart-lung bypass machine. It adds oxygen to your blood and moves the blood through your body. This machine will allow the doctor to stop your heartbeat and replace the valve.

After the doctor has replaced your aortic valve, the doctor will restart your heartbeat. Then the doctor may use wire to put your sternum back together. Your incision will be closed with stitches or staples. The wire will stay in your chest. The incision will leave a scar that may fade with time.

You may stay in the hospital for a few days after surgery.

Aortic valve regurgitation

If your chronic regurgitation is getting worse and you have symptoms, you may choose to have surgery. You might have surgery before you get symptoms, especially if your regurgitation is getting worse. If you have acute regurgitation, surgery will likely be done right away.

Aortic valve stenosis

Valve replacement is recommended based on many things including how severe the stenosis is, whether you have symptoms, and how well your heart is pumping blood. It is typically recommended when a person has severe stenosis.

The valve replacement is typically an open-heart surgery.

During open-heart valve surgery, the doctor makes a large cut (incision) in the chest. Blood is circulated outside of the body through a machine to add oxygen to it (cardiopulmonary bypass or heart-lung machine). The heart may be cooled to slow or stop the heartbeat. This protects the heart from damage while surgery is done to replace the valve with a new valve.

The replacement valve might be mechanical (made of man-made substances). Others are made out of animal tissue.

A minimally invasive surgery or a catheter procedure to replace the aortic valve may be an option for some people.

Valve replacement surgery is done to help you feel better and live longer. Surgery to repair the aortic valve may be done in certain cases.

To help decide if you want surgery, you and your doctor will look at your overall health, your heart health, and how bad your regurgitation is.

Your doctor may check:

• Your symptoms, if you have any.
• Your ejection fraction. This is how much blood your heart is pumping out to your body.
• The size of your left ventricle.

If you have surgery, you can choose a mechanical or tissue valve to replace your heart valve.

Aortic valve regurgitation

Valve replacement surgery helps relieve symptoms and prevent heart failure. And it helps people live longer.

Aortic valve stenosis

Valve replacement surgery is an effective treatment for people who have severe aortic valve stenosis. Surgery can relieve symptoms, improve your quality of life, and help you live longer.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back while you heal. If your breastbone (sternum) was cut, healing usually takes about 4 to 6 weeks.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
• For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
• For at least 6 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, or cat litter or dog food bags.
• For at least 6 weeks, avoid pushing yourself up out of a bed or chair using your arms. Do not use your arms to pull yourself into or out of a vehicle.
• Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You may need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. A dietitian can help you plan meals and learn about healthy foods.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Your doctor may give you a blood thinner to prevent blood clots. If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If you have strips of tape on the incision the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which may delay healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• You can take showers with your back to the showerhead. Allow the warm and soapy water to run across your shoulders and down over the incision. Pat the incision dry with a clean towel.
• Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
• Do not swim or use a hot tub for at least 1 month, or until your doctor says it is okay.
• Do not use any creams, lotions, powders, ointments, or oils unless your doctor tells you it is okay.

Other instructions

• Keep track of your weight. Weigh yourself every day at the same time of day, on the same scale, in the same amount of clothing. A sudden increase in weight can be a sign of a problem with your heart. Tell your doctor if you suddenly gain weight, such as 3 pounds or more in 2 to 3 days.
• Be sure to tell all your doctors and your dentist that you have an artificial aortic valve. This is important, because you may need to take antibiotics before certain procedures to prevent infection.