Minimally Invasive Aortic Valve Surgery

Written by Brian Krans | Published on August 15, 2012
Medically Reviewed by Peter Rudd, MD

What Is Minimally Invasive Aortic Valve Surgery?

Minimally invasive aortic valve surgery is a surgery to replace your heart’s aortic valve with an artificial one. It is performed using a much smaller incision than in open, or “traditional” aortic valve surgery.

The aortic valve is one of the four valves in your heart. Your heart valves are flaps of tissue that open and close to allow blood to flow through your heart in the normal direction. The aortic valve opens to allow blood to leave the left ventricle and move into the aorta, and then closes to prevent backflow.

According to the Cleveland Clinic, minimally invasive aortic valve surgery is considered the gold standard of care for people with isolated aortic valve disease (Cleveland Clinic).

Why Minimally Invasive Aortic Valve Surgery Is Performed

A malfunctioning aortic valve can cause serious symptoms and complications, including:

  • chest pain
  • fainting
  • shortness of breath
  • heart failure

Over time, aortic valve dysfunction can lead to aortic regurgitation (a pooling of blood in the heart) or heart failure.

The Risks of Minimally Invasive Aortic Valve Surgery

Every surgical procedure carries the risk of certain complications, including infection and excessive bleeding. Compared to open aortic valve surgery, the minimally invasive technique carries a much lower risk of pain, infection, and blood loss and offers a quicker recovery time.

While replacement valves rarely fail, they can cause blood to clot in the area of your heart. If a clot travels from the heart to your brain, you could have a stroke. You will be prescribed blood-thinning medication after surgery to try to prevent clots from forming.

How to Prepare for Minimally Invasive Aortic Valve Surgery

Ask your doctor about the type of replacement heart valve you’ll be receiving. There are two different types of replacement valves:

  • biological: these valves are made from animal or human tissue. They typically last about a decade, but if you have one implanted there’s a chance you won’t need to take blood thinners for the rest of your life.
  • mechanical: made of titanium or ceramic, these valves will last for at least 30 years, but you’ll have to take blood thinners for the rest of your life to allow the valve to function properly.

During appointments prior to your surgery, your doctor will take a complete medical history and perform a physical examination. Be sure to tell your doctor about any medications, vitamins, or supplements you’re taking. You may be instructed to stop taking them up to two weeks before surgery.

There is a chance you will need a blood transfusion during or after the surgery. This is fairly normal, and is due to blood loss during the procedure. You may be able to have your own blood drawn and stored in a blood bank before the surgery. It may also be possible for family members to donate blood for your transfusion.

Your doctor will give you a special soap to clean your body with the day before your surgery. You will be instructed to not eat or drink anything—including chewing gum— beginning at midnight the night before your surgery. If you’re starting to feel sick or if you have a cold, tell your doctor before the surgery. Your surgery may have to be postponed until you are well.

How Minimally Invasive Aortic Valve Surgery Is Performed

Aortic valve surgery typically takes between three and six hours. You’ll be under general anesthesia, so you will feel as though you are in a deep, peaceful sleep. While you’re sleeping, you will be attached to a heart-lung bypass machine, a device that does the work of your heart and lungs during the surgery.

During the procedure, your doctor will make a single incision in one of four places in your torso. The most common incision point is on the right side of the chest near the breastbone. The incision will be 2 or 3 inches wide. The surgeon will then move your chest muscles aside to access your heart.

Another approach involves making several smaller incisions in your chest and using endoscopic tools to perform the surgery. These are long, thin tubes that contain both the surgical instruments and a camera to view the structures being operated on. The most precise endoscopic method uses robotic arms that the surgeon controls while viewing 3-D images of the heart and its valves on a monitor.

Once your surgeon accesses the aortic valve, he or she will remove the old valve and surgically implant a new one. The surgeon will ensure that the valve is working, close the incision in your heart with dissolving stitches or sutures, drain accumulated fluids in the chest, and close all external incisions.

After Minimally Invasive Aortic Valve Surgery

Expect to spend three to seven days in the hospital after your aortic valve surgery. You will spend the first day in an intensive care unit where you will be closely monitored.

During this time, you may be connected to an IV for fluids going in and a catheter to collect fluids coming out. You’ll also be connected to an EKG machine so that doctors and nurses can monitor your heart rate.

Recovery from this type of surgery will take time. How much time depends on your overall health and how well your body responds to the new valve. You will meet with your doctor several times in the following months to ensure that your new valve is functioning normally. Be sure to follow all your doctor’s postoperative instructions.

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