Aortic Valve Replacement: Open

An open, invasive aortic valve replacement is a surgery to replace a poorly working aortic valve with an artificial valve. The aortic valve is one of the heart’s 4 valves. These valves help blood flow through the heart and out to the body. Under certain circumstances, your valve can stop working well. Your surgeon will use an artificial valve to replace your poorly working valve. This will ensure that your blood can exit the heart and flow out to the body normally. The surgery is called "open" because it uses a traditional type of incision to expose your heart. This incision is larger than those in minimally invasive types of aortic valve replacement surgery.

Why might I need an open aortic valve replacement?

When your aortic valve is working poorly such as in aortic valve stenosis or aortic valve regurgitation, you may need this procedure.

• In aortic stenosis, your valve is unable to open fully, and less blood is able to exit your heart.
• In aortic regurgitation, your valve is leaky. Some blood leaks backward through the valve instead of moving out to the rest of your body.

In both of these cases, you may need to have your aortic valve replaced. A poorly working aortic valve may lead to symptoms, such as:

• Shortness of breath
• Fatigue
• Swelling in your legs
• Dizziness
• Chest pain
• Passing out
• An unpleasant awareness of your heartbeat

If these symptoms get worse, surgery may be needed. Your doctor may recommend the surgery even if you don’t have significant symptoms, since surgery is most effective if symptoms are not too advanced.

Both aortic stenosis and aortic regurgitation can result from general aging of the valve. Other causes of aortic valve disease include:

• Heart birth defects (like a bicuspid aortic valve)
• Bacterial infection of the heart valve
• A tear in the aorta
• Aortic aneurysm (weakened, stretched aorta wall)
• Certain genetic conditions (like Marfan syndrome)

What are the risks of an open aortic valve replacement?

There are certain risks with any type of surgery. Your particular risks will vary based on your particular medical condition, your age, and other factors. Be sure to talk with your doctor about any concerns that you have.

Most people who have open aortic valve replacement will have a successful outcome. However, there are some possible risks. These include:

• Infection
• Bleeding
• Irregular heart rhythms
• Blood clots leading to stroke or heart attack
• Complications from anesthesia

Certain factors increase the risk of complications. Some of these are as follows:

• Chronic illness
• Other heart conditions
• Lung problems
• Increased age
• Being overweight
• Being a smoker
• Infections

How do I get ready for an open aortic valve replacement?

As you plan for the surgery, you and your healthcare provider will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve.

• Biological valves are made mainly from pig, cow, or human heart tissue. Biological valves don’t last as long as mechanical valves but have less risk for blood clots.
• Mechanical valves are man-made. People with mechanical valves need to take blood-thinning medicines for the rest of their lives because of the risk for blood clots. Mechanical valves also have an increased risk for infection.

Talk with your healthcare provider about how to prepare for your upcoming surgery. Remember the following:

• Avoid eating or drinking anything after midnight before your surgery.
• Try to stop smoking before your operation. Ask your doctor for ways to help.
• You may need to stop taking certain medicines before your surgery. Follow your healthcare provider’s instructions if you usually take blood-thinning medicine like warfarin or aspirin.

You may arrive at the hospital the afternoon before your operation. This is a good time to ask any questions you have about the procedure. You may need some routine tests before the procedure to assess your health before surgery. These may include:

• Chest X-ray
• Electrocardiogram (ECG)
• Blood tests
• Echocardiogram (to assess your current valve)
• Coronary angiogram (to assess blood flow in your heart arteries)

About an hour before the operation, someone will give you medicines to help you relax. In most cases your surgery will proceed as planned, but sometimes another emergency might delay your operation.

What happens during an open aortic valve replacement?

Check with your doctor about the details of your procedure. In general, during your open aortic valve replacement:

• You will be given anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards you won’t remember it.
• The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
• Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
• The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
• Your surgeon will remove your current heart valve and replace it with a new valve.
• The surgery team will remove the heart-lung machine.
• The team will wire your breastbone back together.
• The team will then sew or staple the incision in your skin back together.

What happens after an open aortic valve replacement?

After your open aortic valve replacement:

• You will start your recovery in the intensive care unit or a recovery room.
• When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
• Most people who have aortic valve replacement notice immediate symptom relief after their surgery.
• The team will monitor your vital signs, such as your heart rate. They may hook you up to several machines so the nurses can check these more easily.
• You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
• You may have a chest tube to drain excess fluid from your chest.
• You may have small temporary pacemaker wires exiting from your chest
• Bandages will cover your incision. These can usually come off within a couple of days.
• You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
• In a day or two, you should be able to sit in a chair and walk with help.
• You may do breathing therapy to help remove fluids that collect in your lungs during surgery.
• You will probably be able to drink liquids the day after surgery. You can have regular foods as soon as you can tolerate them.
• You may receive elastic stockings to help blood circulate through your leg veins.
• You will probably need to stay in the hospital around 5 days.

After you leave the hospital:

• Make sure you have someone to drive you home from the hospital. You will also need some help at home for a while.
• You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
• You may tire easily after the surgery, but you will gradually start to recover your strength. It may be several weeks before you fully recover.
• After you go home, take your temperature and your weight every day. Tell your doctor if your temperature is over 100.4°F (38°C), or if your weight changes.
• Ask your healthcare provider when it is safe for you to drive.
• Avoid lifting anything heavy for several weeks. Ask your healthcare provider about what is safe for you to lift.
• Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
• Make sure all your dentists and other healthcare providers know about your medical history. You may need to take antibiotics before certain medical and dental procedures to prevent getting an infection on your replacement valve.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure

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