About the Procedure and Recovery of Aortic Valve Surgery

Aortic valve surgery is a procedure used when the heart’s aortic valve becomes narrowed (aortic stenosis) or leaky (aortic regurgitation). These conditions can affect how blood moves through the heart and lead to symptoms like shortness of breath, fatigue or chest discomfort and more serious complications if left untreated.  

This article covers what aortic valve surgery involves, the different surgical options available and what to expect before and after the procedure. If you have been referred for assessment or are looking at treatment options in Melbourne, reading this information can support discussions with your GP for specialist referral.

What is the Aortic Valve?

The aortic valve is one of the four valves of the heart. It is located between the left ventricle (the heart’s main pumping chamber) and the aorta (the large blood vessel that carries oxygen-rich blood to the body). The aortic valve’s primary role is to open and close with each heartbeat, helping blood flow in one direction from the heart to the rest of the body.

When the aortic valve becomes diseased or damaged, it can affect the heart’s ability to pump blood as effectively, leading to serious health problems. In some cases, aortic valve surgery may be needed to repair or replace the valve.

Why Would You Need Aortic Valve Surgery?

Aortic valve surgery may be recommended if you have a narrowed aortic valve (aortic stenosis) or a leaky valve (aortic regurgitation), both of which can place extra strain the heart and lead to symptoms such as:

• Shortness of breath, especially with exertion.
• Chest pain or discomfort.
• Fatigue or feeling unusually tired.
• Swelling in the ankles, feet, or abdomen.
• Fainting or dizziness, especially during physical activity.
• Heart palpitations (irregular heartbeats).

These symptoms may occur because a damaged aortic valve prevents the heart from functioning efficiently, which can lead to heart failure or other complications if left untreated.

Aortic valve surgery is typically recommended when symptoms are impacting your day-to-day or when the condition is affecting the heart’s function, as assessed through medical testing and imaging.

Types of Aortic Valve Surgery

There are two main types of aortic valve surgery: valve repair and valve replacement. The choice between repair and replacement depends on the severity and cause of the valve disease, as well as your overall health.

1. Aortic Valve Repair

In some cases, the aortic valve can be repaired to improve how it functions. This procedure is more common when the valve is damaged but still structurally able to be repaired. Dr Adrian Pick will assess if repair is suitable based on the condition of your valve and expected durability, keeping you informed throughout the process. Aortic Valve Repair may involve:

• Reshaping the valve to help it close properly.
• Reattaching or tightening the valve flaps (leaflets).
• Removing excess tissue or scar tissue that prevents the valve from closing properly.

2. Aortic Valve Replacement

If the aortic valve is too damaged to be repaired, Dr Adrian Pick will replace the valve with an artificial one. There are two main types of replacement valves:

• Mechanical valves: Made of durable materials, such as metal or carbon. These valves are long-lasting but require lifelong blood thinning medication (anticoagulants) to reduce the risk of blood clots.
• Biological (tissue) valves: Made from animal tissue (such as pig or cow valves) or human tissue. These valves do not usually require long-term anticoagulants but may need to be replaced after 10 to 20 years, depending on the patient’s age and health.

Minimally Invasive Aortic Valve Surgery

For selected patients, Dr Adrian Pick may perform aortic valve surgery using minimally invasive techniques. These methods involves smaller incisions, which can offer potential benefits when compared to traditional open-heart surgery.

Potential Benefits compared to open-surgery:

• Less discomfort following surgery due to smaller incisions and less tissue disruption.
• Shorter hospital stay, with some patients able to go home within days.
• Faster recovery, associated with an earlier return to usual activities.
• Smaller scars that are less noticeable from smaller incisions.

Types of Minimally Invasive Techniques:

• Right Anterior Thoracotomy: A small incision is made on the right side of the chest.
• Subxiphoid Method: A small incision is made just beneath the breastbone (xiphoid process).
• Trans Axillary Approach. An incision in the axillae. With next and groin cannulation for bypass allows excellent access to the aorta with enhanced exposure compared to RATS approach and superior cosmesis
• Transcatheter Aortic Valve Replacement (TAVR): For certain patients, Dr Adrian Pick may coordinate this procedure where the aortic valve is replaced without open surgery using a catheter that is inserted through a blood vessel. This is typically used for patients who are at higher risk for traditional surgery.

Traditional Aortic Valve Surgery (Open Surgery)

Open surgery may be recommended by Dr Adrian Pick in more complex situations or where full access to the heart is required. This involves a larger incision down the chest and splitting the breastbone (sternotomy) to access the heart. This is an established and effective surgical option used across a range of aortic valve conditions. It does, however, involve a longer recovery time and more potential complications than minimally invasive techniques.

Potential Benefits:

• Wide access to the heart, making it suitable for complex cases.
• Established surgical method used in a range of aortic valve conditions.

Limitations:

• Longer hospital stay of around 7-10 days.
• Longer recovery period of fatigue and activity limitation for at least 6 weeks.
• Pain around the chest incision is normal.
• Larger scars from the chest incision.

What to Expect During Aortic Valve Surgery

1. Pre-Surgery Preparation

Before surgery, you will have several tests to assess your heart function and overall health, including:

• Echocardiogram (ultrasound of the heart).
• Electrocardiogram (ECG) to assess heart rhythm.
• Chest X-ray or CT scan for imaging.
• Blood tests to evaluate kidney function, clotting, and other markers.

Dr Adrian Pick will review and discuss your results with you and explain the type of surgery, including options, expected hospital stay and recovery considerations specific to you.

2. The Surgery

Aortic valve surgery typically takes 2 to 4 hours, depending on the complexity of the procedure and the type of surgery. General anaesthesia will be used, so you will be asleep during the procedure.

3. Post-Surgery Recovery

After surgery, you will spend a few days in the hospital for observation and recovery. Your dedicated healthcare team will monitor your heart function and confirm that you are stable before discharging you from Dr Pick’s care. You will be encouraged to move around to reduce the risk of blood clots and start breathing exercises to keep your lungs clear, both supporting your early recovery.

Risks of Aortic Valve Surgery

Like any surgery, aortic valve surgery carries risks. These may include:

• Infection at the incision site or around the heart.
• Bleeding during or after surgery.
• Arrhythmias (irregular heartbeats).
• Blood clots.
• Valve dysfunction (in some cases, the replacement or repair may not function as intended).

Dr Adrian Pick will discuss these risks with you in detail, including how they relate to your individual health and planned procedure.

Post-Surgery Care and Long-Term Management

After surgery, you will need regular check-ups with your GP to monitor your heart’s function and review how the valve is working. You may need:

• Echocardiograms to monitor the repaired or replaced valve.
• Medications such as anticoagulants (if you have a mechanical valve) or medications for blood pressure management and heart function.
• Lifestyle changes, including a balanced diet, regular exercise and monitoring for symptoms.

Moving Forward with Treatment

Aortic valve surgery can improve your heart health and quality of life, especially if you have severe aortic valve disease that may be affecting your quality of life. A referral and thorough discussion with a Cardiothoracic Specialist, like Dr Adrian Pick, can help you understand your options and, if clinically required, what type of surgery is recommended specific to your condition and health. Early intervention is important in managing your condition and improving your heart health.

Ask your GP about a referral to Dr Adrian Pick to discuss your treatment options.

Already have a referral?

References:

1. Heart Foundation. (2024). Key statistics: Cardiovascular Disease | Heart Foundation. Heartfoundation.org.au. https://www.heartfoundation.org.au/your-heart/evidence-and-statistics/key-stats-cardiovascular-disease
2. American Heart Association. (2016). Heart Valve Surgery Recovery and Follow Up. www.heart.org. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/recovery-and-healthy-living-goals-for-heart-valve-patients/heart-valve-surgery-recovery-and-follow-up
3. After Heart Valve Surgery – St Vincent’s Heart Health. (2019). Svhhearthealth.com.au. https://www.svhhearthealth.com.au/rehabilitation/after-heart-valve-surgery
4. Heart valve surgery – discharge : MedlinePlus Medical Encyclopedia. (n.d.). Medlineplus.gov. https://medlineplus.gov/ency/patientinstructions/000291.htm

This article is general information only and is not intended to substitute professional medical advice. Please consult your GP or specialist to discuss your individual circumstances. All surgery carries risk and results may. Dr Adrian Pick (MED0001152485) FRACS, is a Cardiothoracic Specialist, available through referral where appropriate.