Aortic valve repair

The heart is a pumping machine consisting of four chambers, two upper chambers (the atria) and two lower chambers (the ventricles). The right atrium and ventricle get deoxygenated blood from the body, which they send to lungs for oxygenation. From lungs, oxygenated blood reaches the left atrium and then into the left ventricle. From the latter, blood goes into the aorta (the largest artery in the body) and into the whole body. The aortic valve consists of three flap of tissues present between the left ventricle and aorta. This valve opens and closes at the right time to allow the flow of blood in the forward direction and keep it from moving back to the left ventricle.

If you have a diseased or damaged valve, the valve will not open properly (stenosis or narrowing) or close completely (causing regurgitation or backflow from the valve). In both circumstances, a surgery may be needed to correct the damage.

Aortic valve repair surgery is performed to treat conditions associated with the aortic valve.

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A doctor may recommend this surgery if you have aortic stenosis or regurgitation. Some of the symptoms of problems of an aortic valve are as follows:

• Fatigue 
• Swelling of ankles 
• Easy exhaustion 
• Loss of energy 
• Shortness of breath 
• Dizziness or fainting
• Palpitations (irregular heartbeats)
• Chest pain

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A doctor may not perform a valve repair surgery if your heart valves are severely damaged. In such a situation, you may need a valve replacement surgery.

Some other contraindications to this surgery are as follows:

• Excessive calcium deposition on the valve 
• Stiffness of the leaflets of the valve
• Retraction of valve leaflets

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Before undergoing this surgery, you will need the following preparation:

• Your doctor will perform a complete physical examination and evaluate your symptoms. He/she may also conduct diagnostic scans like echocardiogram to visualise the condition of the heart.
• You will need to restrict eating and drinking for a few hours, especially from midnight before the surgery.
• Tell your healthcare practitioner about all the medicines you take, including prescribed and non-prescribed medications, supplements, and herbs.
• The doctor will ask you to discontinue blood thinner medicines like aspirin, warfarin, or clopidogrel for a week before the surgery as they may increase the risk of increased bleeding during the procedure.
• You will be advised to stop smoking to improve the chances of speedy recovery after the surgery.
• Inform your healthcare provider if you:
  • Have implanted heart devices like a pacemaker 
  • Are allergic to any medicines or surgical materials like tape, iodine, latex, or anaesthetic agent
  • Are or can be pregnant 
  • Have a cold, flu, or any illness in the days preceding your surgery
• You will need to sign a consent form for the surgery.
• You will need someone, a family member or a friend, to take you home after the surgery.

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The medical team will provide you with a hospital gown to change into and ask you to empty your bladder. The surgery will be done in the following manner.

• You will be asked to lie on an operation table in a supine position, i.e., on your back. 
• An intravenous (IV) line will be initiated in your arm or hand to supply medicines and fluids. 
• Your doctor will introduce multiple tubes inside the body. They include:
  • A breathing tube inside your lungs, which is connected to a machine that will help you breathe (ventilator)
  • A catheter inside your bladder to drain urine
  • A tube inside your stomach to remove stomach contents
• The surgeon will shave the surgical area to remove excess hair and clean the area with an antiseptic solution.
• You will be given general anaesthesia to keep you asleep during the procedure.

Aortic valve replacement is done either through an open heart or minimally invasive surgery.

For open heart surgery, the following steps will be performed: 

• The surgeon will make an extended cut in the middle portion of your chest and cut your breastbone to access your heart and aorta.
• Your heart will have to be stopped for the procedure. The surgeon will insert a tube inside your heart and attach you to a heart-lung bypass machine, which will supply blood throughout the body when your heart is stopped.
• He/she will then stop the pumping of your heart using a cold solution.
• The damaged valve will be repaired by reshaping the parts of the valve or repairing the leaflets on the valve to ensure improved heart function.

The following steps are performed during a minimally invasive surgery:

• The surgeon will make a small cut in the right portion of your chest and move your chest muscles aside.
• In robotic-assisted valve surgery, a computer is used to control the arms of a robot, and 2-4 small cuts are made on the chest.
• The surgeon will cut the top part of your breastbone to expose the aortic valve.
• He/she will stop your heart and attach it to a heart-lung bypass machine. 
• Next, the surgeon will repair the aortic valve either by reshaping it or correcting the leaflet portion of the valve.

Once the valve is repaired, your surgeon will:

• Restart your heart 
• Remove the bypass machine and allow the blood to flow normally through your heart 
• Examine the function of the valve and your heart
• Rejoin your breastbone using small wires
• Insert a drain tube to remove the accumulated fluid around your heart 
• Seal the surgical cut on your muscles and skin.

This procedure may take about three to six hours. Minimally invasive surgery needs less time as compared to open heart surgery.

After the surgery, the medical team will shift you to the intensive care unit (ICU) to monitor you for a few days. This procedure requires a hospital stay of three to seven days.

During your stay in the hospital: 

• The nurse will monitor your vital signs like blood pressure, heart rate, and oxygen level. 
• Your breathing will also be monitored. Initially, you will be on a ventilator. However, as you start breathing normally, the breathing tube will be removed. At this point, the tube in your stomach will also be removed.
• Once you feel stable, you can consume liquid and solid food.

Later, you will be shifted to a recovery room to examine your progress after the surgery. All other tubes will be removed before you leave the hospital.

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Once you are home after the surgery, you will need to take the following care:

Wound care: Your wound may take four to six weeks to heal completely. During this time, you should take precautions while moving your upper body and arms. Keep the surgical area clean with water and soap. You should avoid doing the following things until your wound has completely healed:

• Heavy lifting as it can cause a pulling sensation across the chest
• Reaching backwards 
• Any activity that requires pulling on an arm 

Diet: 

• Take a diet low in cholesterol, fat, and high in fibre.
• You will be provided with a diet plan after the surgery. If not, it is best to take a balanced diet as it will help in quick recovery and weight control. 
• Avoid processed meat and food items containing high sugar and salt.

Medications: 

• If you are taking medications for diabetes, high blood pressure, or heart disease your doctor will suggest you to continue them. 
• You will be prescribed blood-thinning medications to prevent the formation of blood clots.

Activities:

• Stay active to recover fast after the surgery. However, do not do heavy exercise at once, increase the pace of your activities gradually.
• You should walk for at least 150 minutes per week to keep your lungs and heart healthy.
• Your doctor will advise you to avoid sitting or standing in one place for a long time.
• Stop doing any activity if you experience dizziness, shortness of breath, or chest pain. 
• You can resume work after six to eight weeks.

Bathing or showering: You will be allowed to take only a 10-minute shower with lukewarm water. Avoid taking a bath in a hot tub or swimming until your wound has fully healed.

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When to see the doctor?

Contact the doctor immediately if you experience the following symptoms:

• Fever above 100.4^°F
• Bleeding gums or nosebleeds
• Difficulty in breathing 
• Increased swelling in the abdomen or legs
• Irregular or rapid pulse
• Escalating pain around the operated site 
• Weakness in limbs 
• Continuous nausea or vomiting 
• Dizziness
• Increased bruising 
• Weight gain by more than 1 kilogram in a day for two days consecutively
• Redness, bleeding, drainage, or swelling on the incision site 
• Headache
• Coughing up blood or green/yellow mucus
• Infection

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The following risks are associated with this surgery:

• Heart attack or stroke 
• Irregular heartbeats that require the use of a pacemaker or medicines 
• Damage to other organs, bones, or nerves 
• Blood loss 
• Post-pericardiotomy syndrome that involves chest pain and low fever for up to six months
• Infection in the kidneys, chest, heart valve, or bladder 
• Poor wound healing
• Kidney failure
• Loss of memory and reduced mental clarity

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A follow-up appointment will be scheduled before you are discharged from the hospital to remove staples or stitches from the surgical site.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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