Aortic Valve Replacement Surgery in India

What is Heart Valve Replacement Surgery?

Heart valve replacement surgery is an option if the valves of your heart are too fragile, scarred, or damaged. Valvular heart disease develops when one or more of the heart’s four valves do not function properly. There are four valves in the heart namely the mitral valve, aortic valve, tricuspid valve and pulmonary valve. Each valve has flaps called leaflets, the mitral valve has only two leaflets; but the aortic, pulmonic and tricuspid valves have three. As the heart pumps blood, these valves open and close tightly. The valve ensures that blood flows in only one direction, preventing backflow.

This article will help you to understand Aortic valve replacement surgery.

What is Aortic valve replacement?

Aortic Valve Replacement is a surgical approach to replace a defective aortic valve. This may be required if the aortic valve does not fully open or completely close. The aortic valve opens so blood can flow out and it closes to keep blood from leaking backwards to the heart. The Aortic valve is an essential part of your heart and if your Aortic valve is completely damaged then you may need Aortic valve replacement surgery. Your doctor will recommend Aortic valve replacement surgery for the following heart conditions:

  • In Aortic valve stenosis (narrowed valve opening), where the leaflets become thick or stiff, and the valve is unable to open completely, resulting in reduced blood flow from the left ventricle into the aorta. This can occur due to hereditary factors, ageing, rheumatic fever, or the build-up of calcium or cholesterol on the leaflets. When Aortic stenosis is left untreated, it can lead to heart failure or death.
  • In Aortic valve prolapse (bulging valve), where the Aortic valve leaflets are floppy or loose. Aortic valve prolapse leads to Aortic valve regurgitation.
  • In Aortic valve regurgitation (leak in a valve), where the blood flows backwards into the heart causing the heart to work harder to pump blood, and the leaking valve needs to be corrected. This leaking can occur because of a heart defect, damage from a heart attack, advanced age, or even a bacterial infection in your valve. 

Once the Aortic valve is damaged it loses the ability to pump blood, then Aortic valve replacement is recommended. But before the surgery, you will need to select the type of valve. 

What are the types of Replacement Valves?

When you plan for the surgery, you and your surgeon can decide which type of valve will work best for you. Then your surgeon will replace your valve with a biological valve or a mechanical valve based on your preference and medical condition. 

  • Biological valves, also called bioprosthetic valves, are made from human heart tissue or animal tissue. Biological valves eventually need to be replaced, as they degenerate over time. Biological valves will not last as long as mechanical valves. 
  • Mechanical valves are man-made and are created from carbon and polyester materials that the human body tolerates well. They can last between 10 to 20 years. Mechanical valves may have an increased risk of infection and stroke. Therefore, you will need to take blood-thinning medicine for the rest of your life to prevent blood clots and reduce your risk of stroke.
  • In the Ross procedure or pulmonary autograft procedure, your own pulmonary valve tissue is replaced with the defective aortic valve.

Once the valve is selected, you are prepared for the Aortic valve replacement surgery. 

How is Aortic valve replacement performed?

The Aortic valve replacement is performed under general anaesthesia through open-heart surgery or a minimally invasive procedure.  Open-heart surgery requires a large incision from your neck to your navel but the minimally invasive procedure requires a small incision. 

  1. Step 1 – You will be placed on a bypass machine that keeps blood circulating through your body and your lungs functioning during surgery. 
  2. Step 2 – Your surgeon will make an incision through which the current Aortic heart valve will be removed and replaced with a new valve.
  3. Step 3 – The surgery team will remove the bypass machine and the team will wire your breastbone back together. 
  4. Step 4 – Your surgeon will then sew or staple the incision in your skin back together.

What happens after Aortic valve replacement surgery?

After your surgery, you will be shifted to the intensive care unit (ICU) depending on your condition and surgery. 

  • Your medical team will monitor your condition for signs of infection in your incision sites. 
  • Your team will monitor your blood pressure, breathing and heart rate. 
  • Your treatment team will instruct you to walk regularly to gradually increase your activity, to cough and to do breathing exercises as you recover.
  • After Aortic Valve Replacement, your physician will advise you to avoid foods that are high in sugar and sodium. This includes processed foods and baked goods that may contain artificial preservatives.
  • Follow-up appointments are important and will help your doctor determine whether you are ready to resume your everyday activities, such as working, driving and exercise.

What are the complications of Aortic valve replacement surgery?

The Possible risks include the following:

  • Bleeding
  • Blood clots
  • Valve dysfunction in replacement valves
  • Heart rhythm problems
  • Infection
  • Stroke
  • Death

Life after an Aortic valve replacement:

Full recovery can take a few weeks or up to several months, depending on your rate of healing and the type of surgery performed.  

  • An echocardiogram is recommended annually to assess valve function. 
  • Your doctor may instruct you to make healthy lifestyle changes including physical activity, a healthy diet, stress management and avoiding tobacco use.
  • Your doctor may recommend you to participate in the cardiac rehabilitation program of education and exercise. This is designed to help you recover, improve your overall cardiovascular health and reduce the chances of a heart attack, heart failure or other complications with the aortic valve in the future.

Frequently Asked Questions:

What is Transcatheter Aortic Valve Replacement?

Transcatheter Aortic Valve Replacement is a surgical approach in which High-risk aortic valve stenosis is treated and it is also called Transcatheter aortic valve implantation. This is a minimally invasive procedure that involves a shorter hospital stay and quicker recovery compared to open-heart surgery.  

How is a Transcatheter Aortic Valve Replacement performed?

  1. Step 1 – The heart is accessed through the leg (groin) or chest.
  2. Step 2 – A catheter (hollow tube) is inserted and guided to the heart through blood vessels. 
  3. Step 3 – The tube is positioned at the defective aortic valve and a balloon is inflated to place the new valve. 
  4. Step 4 – Once the new valve has been positioned properly, the catheter is withdrawn from the blood vessels, and the incision is closed.

This method is recommended for people if open-heart surgery is too risky.

What is the common complication of Aortic Valve Replacement?

Heart attack, stroke and chest wound infection has been reported in the case of open-heart surgery.

When does a person need aortic valve replacement?

You may need aortic valve surgery to replace the aortic valve in your heart:

  • If your aortic valve does not close completely, then blood leaks back into the heart. This is called aortic regurgitation.
  • If your aortic valve does not open fully, so blood flow out of the heart is reduced. This is called aortic stenosis.

What is a double valve replacement?

A double valve replacement is a replacement of both the mitral and the aortic valve or the entire left side of the heart. This type of surgery is not as common as the others and the mortality rate is slightly higher.

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