What is Aortic Valve Replacement Surgery ?

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What is the meaning of Aortic Valve Replacement Surgery?

Aortic valve replacement surgery is a procedure involving the removal of a damaged or faulty aortic valve and replacing it with a new valve that is made of synthetic materials or animal tissues. Aortic valve replacement is a type of treatment performed for various diseases that affect the aortic valve, which is one of the four valves that control the blood flow through the heart. The aortic valve is present between the left ventricle (the lower left chamber of the heart) and the aorta (the largest artery in the body). The aortic valve function is to maintain the flow of blood outwards from the heart to the other parts of the body.

Aortic valve replacement is a major type of surgery, and recovery from the procedure may take a long time.

In this article, we will be discussing in detail about aortic valve replacement surgery.

• What are the different types of Aortic Valve Replacements?
• What is the purpose of Aortic Valve Replacement Surgery?
• What are the symptoms that indicate the need for an Aortic Valve Replacement Surgery?
• What is the diagnostic procedure before an Aortic Valve Replacement Surgery?
• How to prepare for Aortic Valve Replacement Surgery?
• What is the procedure for Aortic Valve Replacement Surgery?
• How to care after Aortic Valve Replacement Surgery?
• What are the risks of Aortic Valve Replacement Surgery?
• What is the cost of Aortic Valve Replacement Surgery in India?

What are the different types of Aortic Valve Replacements ?

The aortic valve can be replaced with the following different types of valves:

Biologic valves:

• They are obtained from animal tissue.
• These valves can last for approximately 10 to 20 years.
• These valves do not cause blood clot formation and blood-thinning medications will not be required after their placement.

Mechanical valves:

• They are made up of metal, plastic, or carbon.
• These valves may last for a long time, but they have an increased risk of developing blood clots.
• Blood thinners are prescribed by the doctor after their placement and need to be taken for the rest of the patient’s life. ( Know more about- What is Aortic Valve Surgery ? )

What is the purpose of Aortic Valve Replacement Surgery?

An aortic valve replacement surgery may be performed in the following cases:

Aortic valve stenosis: 

• A condition in which the aortic valve becomes obstructed or narrowed, which makes pumping blood by the heart into the aorta difficult.
• This condition can occur because of a congenital (present at birth) heart disorder, thickening of the valve’s closure flaps, or due to inflammatory changes that may occur due to rheumatic heart disease (a condition in which there is permanent damage to the heart valves).

Aortic valve regurgitation:

• A condition in which the blood flows backward through the aortic valve into the left ventricle every time there is relaxation of the ventricle, instead of flowing in a single direction from the ventricle to the aorta. 
• This backflow may occur due to a dysfunctional or leaky valve. A dysfunctional or leaky valve may occur due to an abnormal valve which may be congenital (present at birth), bacterial infection, or deterioration of the valve. ( Know more about- What is Pediatric Cardiac Surgery ? )

Congenital heart disease:

• A congenital heart disease may result in aortic valve stenosis or regurgitation, and may also cause other disorders that prevent the proper functioning of the aortic valve.
• Examples of congenital heart diseases include not having enough cusps or tissue flaps, wrong size or shape of the aortic valve, and atresia (absence of an opening to allow normal flow of blood).

What are the symptoms that indicate the need for an Aortic Valve Replacement Surgery?

Sometimes, a diseased or faulty aortic valve shows no symptoms. However, at other times the following symptoms may indicate a diseased aortic valve that may need replacement:

• Energy loss
• Fatigue
• Weakness 
• Swelling in the ankles
• Palpitations (extra or skipped heartbeats)
• Pain in the chest area ( Know more about- Home remedies for Chest Pain )
• Shortness of breath
• Dizziness ( Know more about- What is Dizziness? Home remedies for Dizziness )
• Loss of consciousness

What is the diagnostic procedure before an Aortic Valve Replacement Surgery?

The following diagnostic tests are performed before an aortic valve replacement surgery:

• Physical examination: The doctor checks for a heart murmur (a swishing sound heard due to abnormal blood flow across the heart valve) using a stethoscope. The presence of a murmur may indicate a possible heart condition.

• Echocardiogram: Sound waves are used to obtain a clear image of the heart and its valves. ( Know more about- What is Echocardiography ? )

• Transesophageal echocardiogram: A small wand-like device, called a transducer, is attached to the end of a tube and inserted through the mouth into the stomach. This enables the doctor to have a closer look at the valves of the heart.

• Electrocardiogram: This test enables the doctor to measure the electrical activity of the heart. 

• Chest x-ray: A chest x-ray helps to identify an enlarged heart, which could indicate the presence of a heart valve disease. 

• Cardiac MRI: This test helps in obtaining a detailed image of the heart.

• Stress tests or exercise tests: These tests help in monitoring the heart’s response to physical exertion.

• Cardiac catheterization: A catheter (tube) is inserted through a blood vessel in the arm or groin region, and then guided to a heart artery. A dye is now injected through the catheter to make the heart arteries visible on an x-ray. This helps the doctor in checking how well the heart functions and measuring the pressure inside the heart chambers.

How to prepare for Aortic Valve Replacement Surgery?

The following preparation may be done before an aortic valve replacement surgery:

• Inform the doctor about any medications, herbs, vitamins, or supplements that the patient is taking.
• Inform the doctor if the patient has any medical conditions.
• The doctor will tell the patient to stop blood thinners like aspirin or warfarin a few days before the procedure.
• The patient should quit smoking at least two weeks before the surgery.
• The patient cannot eat or drink anything after midnight, the night before the surgery.
• The doctor recommends a special soap that needs to be used the night before the surgery in order to kill germs.

What is the procedure for Aortic Valve Replacement Surgery?

An aortic valve replacement surgery is usually performed under general anesthesia (the patient is put to sleep before the procedure). The procedure can be carried out in the following different ways:

Open-Heart Surgery:

• The surgeon creates a 6 to 8-inch incision or cut in the chest area.
• This incision splits open the breastbone.
• The patient’s heart function is stopped, and a heart-lung bypass machine will then take over the function of the heart to pump blood to the rest of the body. 
• The damaged heart valve is replaced with a mechanical or biological valve.
• The heart function is now restarted and the chest incision is closed using sutures (stitches).
• This type of surgery takes about two to four hours to complete.( Know more about- What is Heart Bypass Surgery ? )

Minimally Invasive Aortic Valve Surgery:

• The surgeon creates small incisions of 2 to 4 inches to make a J-shape.
• Aortic valve replacement is carried out by the insertion of a tube with a camera on one end and other small surgical instruments through the incisions made.
• A minimally-invasive surgery causes fewer complications and has a rapid recovery compared to open-heart surgery.

Transcatheter Aortic Valve Replacement (TAVR) procedure:

• This procedure involves using a thin tube (catheter) that runs up from a small opening in the leg or groin region to the heart. 
• The tube is now used by the surgeon to replace the aortic valve. ( Know more about- What is TAVR ? )

How to care after Aortic Valve Replacement Surgery?

• Recovery following a minimally invasive surgery takes only a couple of days. However, recovery after open-heart surgery may take more time.
• It is normal to have some soreness, swelling, and redness following the surgery.
• Loss of appetite, sleep disturbances, and weakness may be experienced after the procedure. These symptoms usually get better with time.
• The breastbone may take approximately six to eight weeks to heal.
• Avoid heavy lifting and other strenuous activities for some weeks after the surgery.
• It may take about three months before the patient can resume his/her normal physical activities.
• Patients having desk jobs can resume their work after six to eight weeks.
• Cardiac rehab and an exercise program may be recommended after the procedure.

What are the risks of Aortic Valve Replacement Surgery?

The various complications associated with an aortic valve replacement surgery are:

• Bleeding
• Infection
• Blood clot formation 
• Irregular heart rhythm
• Kidney disorders ( Know more about- What is Acute Kidney Injury ? )
• Stroke (when the blood supply to the brain stops)
• New valve fails to work well
• Wearing out of the new valve with time

What is the cost of Aortic Valve Replacement Surgery in India?

The total cost of aortic valve replacement surgery in India can range from around INR 3,25,000 to INR 5,25,000. However, there are many large hospitals and experienced doctors in India who perform aortic valve replacement surgery. But the cost of aortic valve replacement surgery may vary across different hospitals.

If you are coming from abroad, apart from the cost of aortic valve replacement surgery, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the procedure, the patient stays in the hospital for 8 days and in the hotel for 10 days for recovery. So, the total cost of aortic valve replacement surgery will be around INR 4,90,000 to  INR 6,00,000.

We hope that we could answer your questions regarding aortic valve replacement surgery through this article.

If you need more information about aortic valve surgery, you can contact a Cardiovascular and Thoracic Surgeon.

We only aim to give you information through this article and do not recommend medication or treatment in any way. Only a qualified doctor can give you good advice and a treatment plan.