Aortic Valve Repair and Replacement

The heart has four valves that control the flow of blood through the heart: the aortic, mitral, tricuspid and pulmonic (also called pulmonary) valves. The aortic valve connects the heart and aorta— the main artery that runs from the heart through the chest and abdomen. When the aortic valve is damaged or diseased, it may not function properly. Two common conditions caused by heart valve disease occur when the heart valve does not close all the way (aortic regurgitation) and when the valve does not open all the way (aortic stenosis).

There are two main types of aortic valve surgery: valve repair and valve replacement. In aortic valve repair, the leaflets are tightened or loosened so that the valve functions properly. With aortic valve replacement surgery, the faulty valve is removed and substituted with an artificial valve. The decision to repair or replace the aortic valve depends on the unique needs of each patient.

Cardiac surgeons at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center are high-volume performers in all types of heart valve surgery, including both valve repair and replacement. This experience and their collaboration with a multidisciplinary team of specialists through the Structural Heart Disease Program enables our surgeons to handle the most complicated cases, with a range of treatment options that improve the lives of cardiac surgery patients throughout the world. These include procedures that allow patients to avoid the use of long-term anticoagulants and minimally invasive treatment options that offer patients a faster recovery with less pain.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Aortic Valve Repair and Replacement

Aortic Valve Repair and Replacement Procedures

Aortic Valve Repair Surgery

Cardiac surgeons at BWH’s Heart & Vascular Center offer a variety of surgical techniques to repair heart valves that are not working properly. Surgical approaches include:

  • Commisurotomy replaces a valve leaflet that is too wide
  • Valvuloplasty uses a balloon to open a stenotic (stiff) heart valve
  • Ring annuloplasty tightens the ring supporting the valve (the annulus) by inserting an artificial ring made of metal, tissue or cloth around the valve

Surgery may also involve:

  • Decalcification to remove calcium to prevent blockage
  • Repair of structural support to reshape the fibrous strings that support the valves
  • Patching holes to stop valve leakage
  • Reshaping a valve to allow it to open and close better

Aortic Valve Replacement Surgery

When your surgeon determines that your heart valve cannot be repaired, he or she may recommend aortic valve replacement surgery.

  • Replacement Valves Damaged heart valves are replaced with a choice of substitute valves including:
    • Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last as long as 30 years and recipients must take lifelong blood thinning medications.
    • Biological valves last for 10 to 15 years and are made from animal tissue or donated human tissue. Patients do not require long-term blood thinning medications.  
Minimally Invasive Aortic Valve Repair and Replacement Surgery

Aortic valve repair or replacement surgery may be performed with minimally invasive surgery compared to traditional (open) heart surgery. We have particular experience and expertise in minimally invasive approaches that uses small incisions. Brigham and Women’s Hospital was one of the first hospitals in the world to successfully perform this type of heart valve operation. Surgeons in the Heart & Vascular Center use their advanced training and experience to perform varied surgical options—unique to each patient—when operating on heart valves:

Minimally invasive heart surgery uses small incisions and has fewer post-operative complications, allowing patients to recuperate faster with less pain. These include:

  • Mini thoracotomy uses a small incision through the ribs.
  • Mini sternotomy is done through a small opening that goes from the top of your breastbone down to the middle.

Percutaneous Intervention

Cardiac surgeons and interventional cardiologists work together to perform percutaneous (needle puncture of the skin) techniques, often recommended for elderly and medically-fragile patients. This includes:

Transcatheter Aortic Valve Replacement (TAVR) may be recommended for high-risk patients with aortic valve stenosis who cannot tolerate open chest surgery. A heart valve is placed on a catheter and inserted through an artery in the upper leg and guided into the heart chambers, where a balloon is inflated to open up the diseased aortic valve. After positioning the catheter, the surgeon inflates the balloon to expand the new valve and secure it into place.

More complex aortic valve repair and replacement surgery may also involve:

  • Hybrid approaches that combine a percutaneous (minimally invasive) coronary procedure with a surgical valve procedure in our hybrid operating room
  • Root-enlarging procedure, effective in smaller aortic valves
  • Aortic root replacement, used in connective tissue disorders, large aortic root aneurysms, endocarditis, or aortic dissections
  • Valve-sparing root surgery for young patients with intact aortic valves and isolated disease of the aortic root who wish to avoid blood-thinning medications
  • Stented biological aortic valve replacement
  • Stentless biological aortic valve replacement

Learn more about heart valve repair and replacement surgery.

Read this article about aortic valve replacement without general anesthesia.

Why Have Aortic Valve Repair or Replacement Surgery?

Aortic valve disease may be present at birth or occurs when the valve is damaged by aging. This leads to valve stenosis (narrow valve opening) and regurgitation (leaky valve), two conditions which affect the function of the aortic valve. Your heart must work harder to compensate for these disorders, which can result in inadequate blood circulation to the rest of your body.

Surgery may be recommended if changes in your aortic valve cause:

  • Shortness of breath
  • Chest pain
  • Palpitations
  • Fainting
  • Dizziness
  • Fatigue
  • Low blood pressure

Learn more about heart valve disease.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to surgery, you be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in aortic valve disease. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about cardiac catheterization in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Cardiovascular Center.

LEARN MORE ABOUT BRIGHAM AND WOMEN’S HOSPITAL


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