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Aortic Valve Replacement Surgery

Surgery Overview

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 (aortic valve regurgitation) or is very tight and narrow (aortic valve stenosis), 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, which is used to add oxygen to your blood and move 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, he or she 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 3 to 8 days after surgery.

How It Is Done

In open-heart surgery, the surgeon makes an incision in the middle of the chest

Chest incision site down the middle of the sternum from top to bottom of sternum
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slide 1 of 5, In open-heart surgery, the surgeon makes an incision in the middle of the chest,

Aortic valve replacement surgery may be done as an open-heart surgery or as a less invasive surgery. In open-heart surgery, the surgeon makes an incision in the middle of the chest and cuts through the breastbone (sternum). In less invasive surgery, the surgeon makes smaller incisions and does not open the chest.

In less invasive surgery, the surgeon may make an incision between the ribs

Chest incision site across chest between two ribs
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slide 2 of 5, In less invasive surgery, the surgeon may make an incision between the ribs,

In a less invasive surgery, the surgeon may make an incision between the ribs. The surgeon uses this incision to work on the heart. The surgeon does not cut the sternum.

The chest is opened to expose the heart

slide 3 of 5
slide 3 of 5, The chest is opened to expose the heart,

In an open-heart surgery, the surgeon opens the chest with a retractor to expose the heart. The surgeon opens the lining that protects the heart (pericardium).

The damaged aortic valve is removed

Location of aortic valve in the heart with detail of damaged valve
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slide 4 of 5, The damaged aortic valve is removed,

Next, the surgeon removes the damaged aortic valve.

The artificial valve is sewn in place

Mechanical valve and tissue valve, showing mechanical valve in heart, with detail of valve sewn in place
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slide 5 of 5, The artificial valve is sewn in place,

Finally, the surgeon inserts the artificial valve into the aorta. The artificial valve (also called a prosthetic valve) may be either mechanical or made of animal tissue. The surgeon sews the valve to the annulus, which is a ring of tissue that connects to the leaflets of the aortic valve.

What To Expect

You will recover in the hospital until you are healthy enough to go home. Depending on your overall health, you will likely go home a few days after surgery.

Surgery will likely involve a long recovery over several weeks. You will probably need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel. In some cases, full recovery may take several months.

Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.

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Why It Is Done

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.

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How Well It Works

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. If you don't have the valve replaced when your stenosis is severe, you may die suddenly or develop heart failure. Surgery can relieve symptoms, improve your quality of life, and help you live longer.

Risks

Valve replacement surgery has a lower risk of causing problems if you are otherwise healthy. Although most people have successful outcomes, there is a risk of death and serious problems, such as heart attack and stroke, during surgery. The risks of valve replacement surgery are higher for people who have a failing left ventricle and who have had a heart attack.

If you have severe aortic valve regurgitation or stenosis, the risks of not replacing the valve may be greater than the risks of surgery, unless you have other health problems that make surgery too dangerous.

Even if valve replacement surgery is a success, you may have problems after surgery, such as:

An increased risk of blood clots.

To reduce the risk of blood clots that can cause serious problems, you may take a blood-thinning medicine.

A need for another replacement valve.

This will depend on the type of valve you get and how long you live after you have the surgery.

Incomplete relief from symptoms.

Some types of valves do not have openings as wide as a normal valve for a person your size. This can limit how well the valve works to relieve your symptoms.

A valve that fails.

There is a small chance that the valve will not work. Your doctor will need to check from time to time to make sure that your valve is working.

Credits

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