What is an Aortic Valve Replacement?

Aortic valve replacement is open-heart surgery that corrects problems with the aortic valve. The aortic valve is the opening and closing valve that lies between the left ventricle and the aorta. With each heartbeat, the valve opens, allowing passage of blood into the aorta, which is then distributed to the rest of the body. A properly functioning valve closes shut in between beats so the heart has time to fill with blood. When the aorta doesn’t function properly, it may either be too narrow (stenotic) to let blood through in appropriate amounts, or it doesn’t close tightly and blood leaks back into the heart, which can create left ventricular enlargement and failure.

There are many circumstances under which aortic valve replacement could be considered, and different ways to perform this surgery. Some babies are born with congenital heart defects that necessitate early aortic valve replacement. Conditions can be so bad the valve is completely missing or gravely stenotic or leaky. Adults undergo this surgery too, because they have damage to the valve or because a mild condition in childhood has progressed to a severe point where replacement is necessary to restore heatlh.

When people have this surgery, they may face choices in what type of surgery is most appropriate. Generally, there are three aortic valve replacement strategies that can be tried. Two of these directly replace the valve with either a mechanical valve or a bovine, porcine or cadaver (human) transplant. The old valve is anastamosed (removed) and a new valve attached in its place.

There are disadvantages and advantages for both these choices. Mechanical valves tend to last longer but do mean people must be on anticoagulant therapy, usually taking warfarin (Coumadin®) daily. Biological valves don't typically last for more than 10-15 years, and in children, valves can be outgrown in shorter periods of time and might need replacement every five to 10 years. Neither surgery is without risk, though there is a high rate of success with both.

Another option is a surgery called the Ross Procedure, which may have some advantages, though it is also more complex. In this surgery, the pulmonary valve is removed and used as the aortic valve replacement. Generally a cadaver valve or other biological valve is then used to replace the pulmonary valve. Though complex, the human’s pulmonary valve may be most suited to replace the aortic valve. Finding a competent and experienced surgeon to perform this procedure is highly advised due to its difficulty, and people often go to pediatric cardiothoracic surgeons if they want the Ross.

After a successful replacement, most people recover well and are able to pursue more activities than before because they feel better, though initial full recovery can take a couple of months. Valve replacements down the road may still be needed, and patients may expect careful following with a cardiologist. If a mechanical valve was put in place, warfarin therapy will be necessary, but with attention to diet, regular blood tests and some care when pursuing activities, this therapy can go smoothly for many.