Overview

Aortic valve repair and aortic valve replacement are procedures that treat diseases affecting the aortic valve, one of four valves that control blood flow through the heart.

The aortic valve helps keep blood flowing in the correct direction through the heart. It separates the heart's main pumping chamber (left ventricle) and the main artery that supplies oxygen-rich blood to your body (aorta).

With each contraction of the ventricle, the aortic valve opens and allows blood to flow from the left ventricle into the aorta. When the ventricle relaxes, the aortic valve closes to prevent blood from flowing backward into the ventricle.

When the aortic valve isn't working properly, it can interfere with blood flow and force the heart to work harder to send blood to the rest of your body.

Aortic valve repair or aortic valve replacement can treat aortic valve disease and help restore normal blood flow, reduce symptoms, prolong life and help preserve the function of your heart muscle.

Why it's done

Aortic valve disease treatment depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.

Types of aortic valve disease that may require treatment with aortic valve repair or replacement include:

• Aortic valve regurgitation: This occurs when blood flows backward through the aortic valve into the left ventricle each time the ventricle relaxes rather than in the normal, one-way direction from the ventricle to the aorta. Back flow may be caused by a dysfunctional or leaky valve. This may be due to deterioration of the valve, an abnormal valve shape present at birth (congenital heart disease) or by a bacterial infection.
• Aortic valve stenosis. The stenosis causes the aortic valve to become narrowed or obstructed, which makes it harder for the heart to pump blood into the aorta. This may be caused by congenital heart disease, thickening of the valve's closure flaps (leaflets) or post-inflammatory changes, such as those associated with rheumatic heart disease.
• Congenital heart disease. Having this may contribute to aortic valve regurgitation or stenosis, as well as result in other problems that prevent the aortic valve from working properly. For example, a person may be born with an aortic valve that doesn't have enough tissue flaps (cusps), the valve may be the wrong size or shape, or there may not be an opening to allow blood to flow normally (atresia).

For some people with mild aortic valve disease without symptoms, careful monitoring under a doctor's supervision may be all that's needed.

But in most cases, aortic valve disease and dysfunction get worse despite medical treatment. Most aortic valve conditions are mechanical problems that can't be successfully treated with medication alone. Such conditions eventually require surgery to reduce symptoms and your risk of complications, such as heart failure, heart attack, stroke or death due to sudden cardiac arrest.

Aortic valve repair or replacement?

The decision to repair or replace a damaged aortic valve depends on many things, including:

• The severity of your aortic valve disease
• Your age and overall health
• Whether you need heart surgery to correct another heart problem in addition to aortic valve disease, such as heart bypass surgery to treat coronary artery disease, so both conditions can be treated at once

In general, heart valve repair is usually the first choice because it is associated with a lower risk of infection, preserves valve strength and function, and reduces the need to take blood-thinning medications for the rest of your life, which may be necessary with certain types of valve replacement. For example, people with a hole in the valve's closure flaps (perforated valve leaflet) may be candidates for aortic valve repair rather than replacement, depending on the severity of their condition.

However, most valves cannot be repaired, and heart valve repair surgery is often harder to do than valve replacement. Your best option will depend on your individual situation, as well as the expertise and experience of your health care team.

Aortic valve repair and aortic valve replacement may be done through traditional open-heart surgery, which involves a cut (incision) in the chest, or by using minimally invasive methods, which involve smaller incisions in the chest or a catheter inserted in the leg or chest (transcatheter aortic valve replacement, or TAVR).

Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than traditional open-heart surgery.

What type of procedure you have depends on your individual situation, and your doctor will explain the benefits and risks of each option.

For example, some people with aortic valve disease may not be candidates for traditional open-heart surgery due to other health problems, such as lung or kidney disease, that would make the procedure too risky.

Many people with aortic valve disease also have coronary artery disease and may need heart bypass surgery to improve blood flow. Heart bypass surgery is normally performed through traditional open-heart surgery, so your aortic valve procedure would be performed the same way.

Risks

Aortic valve repair and aortic valve replacement surgery risks vary depending on your health, the type of procedure and the expertise of your health care team. To minimize potential risk, aortic valve surgery should generally be performed at a center with a multidisciplinary heart team experienced in these procedures and that performs high volumes of aortic valve surgeries.

Risks associated with aortic valve repair and aortic valve replacement surgery may include:

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

How you prepare

Before surgery to have your aortic valve repaired or replaced, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.

Discuss with your doctor and treatment team any questions you may have about the procedure.

Before being admitted to the hospital for your surgery, talk to your caregivers about your hospital stay and discuss any help you may need when you return home.

Food and medications

Talk to your doctor about:

• When you can take your regular medications and whether you can take them before your surgery
• When you should stop eating or drinking the night before the surgery

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital including:

• A list of your medications
• Eyeglasses, hearing aids or dentures
• Personal care items, such as a brush, comb, shaving equipment and toothbrush
• Loosefitting, comfortable clothing
• A copy of your advance directive or living will
• Items that may help you relax, such as portable music players or books
• Any prescribed medical devices or equipment

During surgery, avoid wearing:

• Jewelry
• Eyeglasses
• Contact lenses
• Dentures
• Nail polish

Your body hair will be shaved off at the location where the procedure will take place.

Results

After aortic valve repair or aortic valve replacement surgery, you may eventually be able to return to daily activities, such as working, driving and exercise.

You'll still need to take certain medications and attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition.

Your doctor and health care team may instruct you to incorporate healthy lifestyle changes — such as physical activity, a healthy diet, stress management and avoiding tobacco use — into your life to reduce the risk of future complications and promote a healthy heart.

Your doctor may recommend that you participate in cardiac rehabilitation — a program of education and exercise designed to help you improve your health and help you recover after heart surgery.

What you can expect

Research and innovation

Mayo Clinic's doctors and researchers are established pioneers in the field of heart surgery and are involved in numerous international and national studies to improve the technology and techniques used in aortic valve repair and aortic valve replacement.

Researchers study many areas related to heart valve diseases, including research in new blood-thinning medications for people with a mechanical valve replacement and genetics research in people with aortic valve disease.

As a patient at Mayo Clinic, you may have access to more than 100 heart-related clinical trials as a part of your treatment.