Aortic Valve Replacement Surgery

The surgery of the aortic valve replacement is one of the most important surgeries after which the patient will often restore his health after installation of the new valve at a sensitive location inside the heart. The aortic valve is one of the four most important valves in the heart chambers. It is located between the left ventricle and the aorta, regulating blood flow as it is pumped from the left ventricle. Aortic valve replacement surgery can be performed in two ways, either by open heart surgery by fully opening the rib cage or by minimally invasive surgery based on a catheterization.

A cardiologist can decide to replace the patient's aortic valve because of one of the following:

• Aortic valve regurgitation; when blood returns backwards, toward the left ventricle instead. This dysfunction of the aortic valve can be caused by either a congenital malformation or because of a bacterial infection in the aortic valve.
• Stenosis of the aortic valve; because of the blockage or narrowing of the valve which causes the inability of blood to pass through after pumping from the left ventricle. This is often caused by an increase of thickness of the cusps that are responsible for closing the valve or because of a series of changes caused by a previous infection or irritation.

After determining the appointment of the aortic valve replacement surgery, the patient undergoes a series of tests to check his health ability for the surgery, these tests include:

• Blood tests.
• Examine the patient’s health, including a comprehensive cardiac assessment.
• Electrocardiogram (EKG).
• Coronary angiography.
• Chest X-ray.

Although the high success rate of the surgery in replacing the damaged aortic valve with another valid one, it, like most surgical procedures, includes some risks that the patient may suffer after the surgery, for example, general anesthesia may cause some complications for the patient, including:

• Bleeding or some blood clots that may form in the legs and move toward the lungs.
• Breathing problems.
• Interactions with taken medications.
• Infections that may include the lungs, kidneys, chest area, heart valves or bladder.

Other risks include heart attack, stroke, kidney failure, failure of the new valve, poor healing of the surgical wound, or possibly in some cases the surgery may cause death.

This surgery includes three main stages as following:

• Preparing the patient for the surgery:

Once the aortic valve replacement surgery is approved, the patient is prepared by the assistant medical team, but before that, he must go to the hospital to confirm check-in date and complete the procedures, the doctor sits with the patient before starting the surgery preparations and discusses with him all the reasons for surgery and the patient is informed of all the risks clearly and explicitly, the patient signs the consent form of the surgery and the risks involved.

A set of tests are then performed to pre-check the patient's readiness for the surgery, and the patient is asked to shower, use antiseptic soap, and then shave hair on the abdomen or chest, if any. The patient is required to fast from midnight before the day of the surgery. 

Because of the seriousness of such surgeries, the patient should start the preparation phase several days before, through rest, not to practice any strenuous activities and follow a healthy diet.

• During the surgery:

1. The patient receives anesthesia (general anesthesia).
2. Making an incision from 5 cm to 7.6 cm in the right side of the chest next to the sternum (breastbone), so that the incision allows the surgeon to step the muscles aside to expose the heart and the aortic valve.
3. The cardiologist may resort to dividing the sternum for superiorly based clear vision of the heart.
4. Removing the damaged aortic valve and sew the new valve in place. The new valve may be made from a mechanical material (often lasting for a long period of time, but the patient needs to take blood thinners throughout his life) or from living tissues from human or animal origin (often works effectively for 10 to 20 years).
5. The cardiologist checks the valve function properly, and then closes the incision near the heart and aorta.
6. A flexible catheter tube is placed around the heart to drain all fluids accumulated in the area.
7. The surgeon closes the external incision after the muscle has been restored.

In such type of surgery heart-lung machine is often used.

• After the surgery:

After the aortic valve replacement surgery, the patient will stay in the hospital for about a week, he will be moved to the intensive care unit once the surgery is completed, the patient often stays under the anesthetic effect for a few hours and the body's functions are monitored while he is in the care unit. The patient is then given painkillers to alleviate what he feels, and the pulmonary tube is often taken out and replaced with an oxygen mask until he is able to breathe independently. During the first few days, the patient is connected to several devices that enable the medical team to monitor the heart and other organs, after being assured of his condition, he is transferred to a regular room inside the hospital in preparation for checking out from the hospital.

The patient may take quite a while to recover from the side effects of this surgery; that the sternum's healing requires approximately 6 to 8 weeks, while it may take about three months to fully recover from the side effects of the surgery and return to daily activities normally.