Aortic valve surgery - open

Alternative Names: Aortic valve replacement; Aortic valvuloplasty; Aortic valve repair; Replacement - aortic valve

Aortic valve surgery is done to replace the aortic valve in your heart.

Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.

• An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.
• An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.

In open surgery, the surgeon makes a large cut in your breastbone to reach the heart and aorta.

See also: Aortic valve surgery - minimally invasive

Description of Procedure

Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

• Your surgeon will make a 10-inch-long cut in the middle of your chest.
• Next, your surgeon will separate your breastbone to be able to see your heart and aorta (the main blood vessel leading from your heart to the rest of your body).
• Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as titanium or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 10 to 12 years, but you may not need to take blood thinners for life.

Once the new valve is working, your surgeon will:

• Close your heart and take you off the heart-lung machine.
• Place catheters (tubes) around your heart to drain fluids that build up.
• Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.

This surgery may take 2 to 5 hours.

Sometimes other procedures are done during open aortic surgery. These include:

• Coronary bypass surgery
• David procedure
• Graft of the first part of the aorta (large blood vessel leaving the heart)
• Ross (or switch) procedure

Risks of Aortic valve surgery - open

Risks for any anesthesia are:

• Blood clots in the legs that may travel to the lungs
• Blood loss
• Breathing problems
• Infection, including in the lungs, kidneys, bladder, chest, or heart valves
• Reactions to medicines

Possible risks from having open heart surgery are:

• Heart attack or stroke
• Heart rhythm problems
• Incision infection, which is more likely to occur in people who are obese, have diabetes, or have already had this surgery
• Infection of the new valve
• Kidney failure
• Memory loss and loss of mental clarity, or "fuzzy thinking"
• Poor healing of the incision
• Post-pericardiotomy syndrome (low-grade fever and chest pain) that could last up to 6 months

Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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