What is aortic valve replacement surgery?

Aortic valve replacement surgery, or surgical aortic valve replacement (SAVR), performed by a cardiothoracic surgeon, involves making an incision in the chest in order to get to the heart and aortic valve. The heart is stopped, during which time the blood pressure and oxygen levels are maintained with a heart-lung machine (cardiopulmonary bypass). The aorta is opened and the diseased valve removed. It is then replaced with an artificial valve (prosthesis).

There are two valve options for aortic valve replacement (AVR) -- mechanical valves (metal) or biological valves (tissue).

The principal advantage of mechanical valves is their durability -- they do not wear out. However, blood tends to clot on mechanical valves, so people must take blood thinning medication (anticoagulants) for the rest of their lives. There is also a small risk of stroke due to blood clotting.

Biological valves are most commonly made from animal tissue. Biological valves are less likely to cause blood clots, but they also are less durable than mechanical valves and may need to be replaced in the future.

There are two different surgical approaches that can be utilized: traditional AVR or minimally invasive.

During traditional AVR, the cardiothoracic surgeon makes a 6- to 8-inch incision down the center of the breastbone (sternum) to open the chest, providing direct access to the heart. In minimally invasive surgery, the cardiothoracic surgeon makes a 2- to 4-inch, J-shaped incision that opens part of the chest. This can potentially reduce the hospital stay.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.

The term surgery is not quite as easily defined today as it was many years ago. By definition surgery implies a procedure involving an incision, so the traditional surgery for valve replacement was called sternotomy, which is similar to bypass or open-heart surgery and is obviously risky and has a long recovery. During a sternotomy, the surgeon opens up the heart, removes the old valve and sews in a new valve. With the advent of the transcatheter aortic valve replacement (TAVR) technology, you can get a new valve without requiring any incision at all. The TAVR valve is delivered inside a stent, where it is collapsed like an umbrella. The physician pushes the stent through a catheter, which is like a long straw, and it travels into one of the arteries and into the heart. Once inside the heart, the stent opens up, again, like an umbrella, and compresses the old valve against the wall of the heart. The new valve works immediately.

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Aortic valve replacement surgery is a procedure to replace a damaged aortic valve, a part of the heart that controls the flow of blood from the lungs where it has been oxygenated out to the rest of the body. The aortic valve may need to be replaced in someone born with a defective valve, or someone whose aortic valve has stopped functioning properly due to disease, infection, narrowing of the aortic valve (stenosis) which can cause poor blood flow or other problem.

Symptoms of a poorly functioning aortic valve may include shortness of breath, chest pain and dizziness or fainting. If your doctor determines that you have a failing aortic valve that needs to be replaced, you may have an option of choosing either a mechanical valve or a biological valve.

  • Mechanical valves, made of plastic, carbon, or metal, are strong and usually long-lasting. If you receive this type of valve, your doctor may prescribe blood-thinning medicines (called anticoagulants) for the rest of your life.
  • Biological valves, made from animal or human heart tissue, or a graft of a person's own tissue, are usually not as strong as mechanical valves and typically last about 10 years before they need to be replaced. For this reason, they are often recommended for older people who need aortic valve replacement. People who receive biological valves usually do not need to take anticoagulant medications.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.