Open aortic valve surgery is a surgery where the aortic valve in the heart is replaced with an artificial valve. It is done through a larger incision than is used in minimally invasive aortic valve surgery.
The aortic valve is the valve in the heart that opens to allow blood to leave the left ventricle and flow into the aorta, and then closes to prevent backflow. It is made up of three leaflets, although a birth defect can cause some people to have only two leaflets.
Leaflets are strong, thin flaps of tissue that can be compared to doors. They open to allow blood to flow and close to prevent backflow.
While minimally invasive aortic valve surgery is considered the current standard of care for people with isolated aortic valve disease, according to the Cleveland Clinic, some individuals will need open aortic valve surgery.
Sometimes leaflets don’t work properly. They can become stiff and not open fully, restricting blood flow. Leaflets also can fail to close tightly and that allows blood to move back through the valve. Problems with the aortic valve can cause serious health problems. These can include:
- chest pain
- heart failure
- shortness of breath
Over a period of time, this can lead to pooling of blood in the heart (aortic regurgitation) or heart failure.
Doctors will typically first try medication to alleviate your problems, but most serious problems with the aortic valve require surgery.
Every surgical procedure carries certain risks, including infection and bleeding.
Open aortic valve surgery carries more risk that the minimally invasive surgery because of the size of the incision that must be made in the chest cavity. Some of these risks include pain, infection, blood loss, and increased recovery time.
While mechanical valves rarely fail, blood can clot around them. If a clot travels to your brain, you could have a stroke or other health complications. For this reason, your surgeon or doctor may have you take blood thinners for the rest of your life.
Before your surgery, discuss with your doctor the kind of valve you’ll be receiving. There are two types of replacement valves:
- biological—these valves are made from animal or human tissue. They typically last about a decade, but with this type of valve, 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 longer than the rest of your body, but you have to take blood thinners for the rest of your life so the valve can function properly
During your appointments before surgery, your doctor will want to know your complete medical history. He or she also will give you a physical exam. This will include vital signs, blood pressure, and other things. Make sure to tell your doctor about any medications, vitamins, or supplements you may be taking. You may be instructed to stop taking them up to two weeks before surgery.
You may be able to store your own blood in a blood bank, and your doctor can help you find out if your family members can donate for blood transfusions after the surgery.
Your doctor may give you a special soap to shower with to help clean your body the day before surgery.
You will be instructed to not eat or drink anything—including chewing gum—beginning at midnight before your surgery.
If you’re starting to experience symptoms of a cold, tell your doctor before your surgery. That sort of infection could slow healing, and your surgery may have to be postponed until you are well.
Aortic valve surgery typically takes between two and five hours. Don’t worry about passing the time because you’ll be under the deep, peaceful sleep of general anesthesia. While you’re sleeping, you will be attached to a heart-lung machine, which is a device that oxygenates your blood and pumps it through your body during surgery.
During the procedure, your doctor will make a single 10-inch incision in the middle of your chest. He or she will then move your muscles to the side to access your heart.
Once the valve is accessed, your surgeon will remove the old valve and surgically implant the new one. The surgeon will then ensure the valve is working. Once he or she has confirmed the valve is working properly, the surgeon will close the incision in the heart with dissolving stitches or sutures, drain accumulated fluids from the chest, and close the incision in your chest.
Expect to spend three to seven days in the hospital following your aortic valve surgery. Your first day will be spent in an intensive care unit where you will be closely monitored.
During this time, you may receive fluids intravenously, and you may have a catheter to collect urine. You’ll also be connected to an EKG machine so doctors and nurses can monitor your heart rate.
Recovery from this type of surgery will take time. Exactly how much time you will need will depend on your overall health and how well your body responds to the new valve. You will meet with your doctor several times in the months following surgery to ensure that everything is running smoothly. It’s important to pay close attention to your doctor’s instructions and follow them to the letter.