Aortic Valve Replacement

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An open aortic valve replacement is a surgical procedure designed to replace a malfunctioning aortic valve in the heart with an artificial valve. The aortic valve is one of the four valves in the heart responsible for regulating blood flow. When this valve becomes impaired, the surgery involves the insertion of an artificial valve to ensure proper blood flow from the heart to the body. The term "open" refers to the traditional incision method used to access the heart, which is larger than the incisions employed in less invasive aortic valve replacement procedures.

Why Might I Need an Open Aortic Valve Replacement?

An open aortic valve replacement may be necessary when the aortic valve functions poorly, as seen in conditions like aortic valve stenosis or aortic valve regurgitation. Aortic stenosis restricts the valve's ability to open fully, limiting the blood exiting the heart, while aortic regurgitation results in a leaky valve, allowing blood to flow backward instead of properly circulating throughout the body. Symptoms of a malfunctioning aortic valve include shortness of breath, fatigue, leg swelling, dizziness, chest pain, fainting, and palpitations. In cases of worsening symptoms or advanced valve dysfunction, surgery may be recommended. In some instances, surgery might be advised even when symptoms are not severe, as it is most effective in early stages of valve dysfunction. Causes of aortic valve disease can include congenital heart defects, heart valve infections, aortic tears, aortic aneurysms, and specific genetic conditions like Marfan syndrome.

Risks Associated with Open Aortic Valve Replacement:

Like any surgery, open aortic valve replacement carries certain risks, which can vary depending on individual health conditions, age, and other factors. Potential risks include infection, bleeding, irregular heart rhythms, blood clots leading to stroke or heart attack, and complications related to anesthesia. Factors such as chronic illness, preexisting heart conditions, lung problems, age, obesity, smoking, and infections can increase the risk of complications.

Preparing for an Open Aortic Valve Replacement:

Before undergoing open aortic valve replacement, patients, in consultation with their healthcare providers, must determine the type of valve—biological or mechanical—that is most suitable for their situation. Biological valves, crafted from pig, cow, or human heart tissue, have a shorter lifespan but entail a lower risk of blood clots. Mechanical valves, on the other hand, are artificial and necessitate lifelong blood-thinning medication to prevent clotting but have a heightened risk of infection. Preparing for the surgery includes refraining from eating or drinking after midnight on the day prior to the procedure, smoking cessation if applicable, and discontinuing specific medications, particularly blood-thinning drugs such as warfarin or aspirin, following the guidance of the healthcare provider. Patients may arrive at the hospital the day before the operation to address any concerns and undergo pre-surgery tests, including chest X-rays, electrocardiograms, blood tests, echocardiograms to assess the current valve condition, and coronary angiograms to evaluate heart artery blood flow.

The Open Aortic Valve Replacement Procedure:

The open aortic valve replacement procedure is initiated with anesthesia to induce deep and painless sleep. The surgery, which typically lasts several hours, commences with a mid-chest incision and separation of the breastbone to access the heart. A heart-lung machine is employed to temporarily replace the heart and lung functions during the operation. The current aortic valve is removed, and a new valve is implanted in its place. Subsequently, the heart-lung machine is removed, and the breastbone is wired together, followed by suturing the incision on the skin.

Post-Procedure Recovery:

Recovery following open aortic valve replacement begins in the intensive care unit or a recovery room. After waking from anesthesia, patients may experience temporary confusion and may have a breathing tube to aid in respiration, a chest tube for draining excess fluid, and temporary pacemaker wires. Bandages will cover the incision, and patients may feel soreness, which can be managed with pain medication. In a day or two, they may sit in a chair and walk with assistance. Breathing therapy may be administered to remove accumulated lung fluids. Liquids can typically be consumed within a day of surgery, progressing to regular foods once tolerated. Patients may receive elastic stockings to enhance leg blood circulation. Hospital stays last approximately five days before returning home, where recovery continues.

After leaving the hospital, patients should arrange for transportation, have assistance at home, and adhere to follow-up appointments for stitch or staple removal within 7 to 10 days. While recovery may involve fatigue and gradual regaining of strength over several weeks, maintaining daily temperature and weight records is crucial. Driving safety and weightlifting restrictions should be discussed with healthcare providers, and all medical professionals should be informed about the surgery to coordinate necessary precautions. Antibiotics may be recommended before specific dental or medical procedures to prevent infections on the replacement valve.