Centers of Excellence

Heart & Vascular Center

What Is Aortic Valve Repair and Replacement?

The heart has four valves that control the flow of blood: the aortic, mitral, tricuspid and pulmonic (pulmonary) valves. The aortic valve connects the heart and aorta, which is the main artery that runs from the heart through the chest and abdomen. When the aortic valve is damaged or diseased, two common types of heart valve disease may occur:

  • Aortic regurgitation, which is when the valve doesn't close properly, causing blood to flow backward through the valve
  • Aortic stenosis, which is when the aortic valve narrows, reducing blood flow from the left ventricle to the aorta

There are two main types of aortic valve surgery:

  • Aortic valve repair, which is when the leaflets are tightened or loosened so that the valve functions properly
  • Aortic valve replacement, which is when 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 and will be discussed in partnership with the Brigham and Women’s care team.

The Benefit of High-Volume Expertise

Cardiac surgeons at the Brigham and Women’s Hospital Heart & Vascular Center are high-volume performers in all types of heart valve surgery, including both aortic 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 procedures that are minimally invasive, offering 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.

About Aortic Valve Disease

The aortic valve regulates the flow of blood from the heart through the chest and abdomen. Aortic valve disease occurs when the aortic valve is not functioning properly. An improperly functioning aortic valve can lead to many health conditions, including shortness of breath, fatigue, low blood pressure, fainting, chest pain, palpitations and more. The two main aortic valve diseases are aortic valve stenosis and aortic valve regurgitation. Aortic valve disease may be present at birth or occur when the valve is damaged by aging.

Aortic Valve Disease Treatment

Aortic Valve Repair Surgery

Cardiac surgeons at Brigham and Women’s Heart & Vascular Center offer a variety of surgical techniques to repair aortic valves that are not working properly. Attempting to repair aortic valves is typically the first course of action, as it reduces potential post-surgical complications and can preserve the natural function of the aortic valves.

Surgical approaches to repair a damaged or diseased heart valve include:

  • Commissurotomy, which replaces a valve leaflet that is too wide
  • Valvuloplasty, which uses a balloon to open a stenotic (stiff) heart valve
  • Ring annuloplasty, which tightens the ring supporting the valve 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

If the heart valve cannot be repaired, the surgeon may recommend aortic valve replacement surgery. There are different types of aortic valve replacement options available to patients, including:

  • Mechanical valves are 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 through minimally invasive surgery rather than traditional open-heart surgery. 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. The types of incisions include:

  • Mini thoracotomy, a small incision through the ribs
  • Mini sternotomy, a small opening from the top to the middle of the breastbone
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.

Transcatheter Aortic Valve Replacement (TAVR), a percutaneous intervention, 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 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 other percutaneous interventions, such as:

  • Hybrid approaches that combine a minimally invasive coronary procedure with a surgical valve procedure
  • Root-enlarging procedure which are effective in smaller aortic valves
  • Aortic root replacement, often 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
Benefit of Aortic Valve Repair or Aortic Replacement Surgery

When aortic valve stenosis or regurgitation occurs, the heart is forced to work harder, which can result in inadequate blood circulation to the rest of the body.

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

  • Shortness of breath
  • Chest pain
  • Palpitations
  • Fainting
  • Dizziness
  • Fatigue
  • Low blood pressure
Recovery From Aortic Valve Repair and Replacement Surgery

Recovering from an aortic valve repair or replacement surgery depends on the type of procedure. An open-heart surgery will likely include at least one day in the intensive care unit and several more days in the hospital. The breastbone can typically heal in six to eight weeks, but patients should expect up to three months for a full recovery. The less invasive the procedure, the fewer weeks needed for recovery.

Aortic Valve Repair and Replacement FAQs

What Does the Aortic Valve Do?

The aortic valve regulates the flow of blood from the heart and aorta, the main artery running from the heart through the chest and abdomen. The heart has four valves to control blood flow, with the aortic valve positioned between the left ventricle and the aorta.

How Long Does an Aortic Valve Repair Last?

A successful aortic valve repair can improve the quality of life for the patient while extending their life expectancy. A typical aortic valve repair can last years, with a nearly 95% survival rate after five years and nearly 85% after 10 years.

Is Aortic Valve Replacement Considered Major Surgery?

Yes, an aortic valve replacement is a major surgery. Surgical procedures of the heart require highly specialized techniques and may have lengthy recovery times.

How Is an Aortic Valve Replaced?

Replacing an aortic valve can happen through traditional open-heart surgery or through minimally invasive heart surgery techniques. The mini thoracotomy procedure uses a small incision through the ribs, while the mini sternotomy is done through a small opening that goes from the top of the breastbone down to the middle. A transcatheter aortic valve replacement uses a replacement valve on a catheter inserted through an artery in the upper leg and guided to the heart chamber. Once there, a balloon expands the new valve, and a surgeon can secure it into place.

How Safe is Aortic Valve Replacement Surgery?

The expertise of the surgeons at Brigham and Women’s Hospital reduces the risks associated with aortic valve replacement surgeries; however, with any heart operation, risks are still present. Complications may include bleeding, blood clots, infection, stroke and heart rhythm issues. The risks associated with the surgery are typically considered lower than the risk of not treating aortic heart valve disease.

What to Expect at the Heart & Vascular Center

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women’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 will 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 from 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.

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