Aortic valve replacement 

Introduction 

Illustration of aortic valve replacement

Aortic valve replacement

 

  1. Aorta
  2. Coronary artery
  3. Plastic repair of valve
  4. Mitral valve  

 

Having an operation

If your GP has suggested you may need surgery, this guide is for you

Aortic valve replacement is a type of open-heart surgery and is used to treat problems with the heart's aortic valve.

The aortic valve

The heart has four chambers. There are two small chambers at the top of the heart (atria) and two larger chambers at the bottom (ventricles). 

Each ventricle has two valves:

  • one valve controls the blood flowing into the ventricle
  • the other valve controls the blood flowing out of the ventricle

Each valve is made up of flaps, which are also known as leaflets or cusps. These flaps open and close, acting as one-way gates for the blood to flow through.

The aortic valve controls the flow of blood out of the heart's left ventricle to the body’s main artery (the aorta). From here, the blood travels to the rest of the body.

First, the aortic valve opens to allow blood to flow from the heart to the rest of the body. It then closes, to stop any blood leaking back into the heart.

Why is it necessary to replace the aortic valve?

The aortic valve may need to be replaced for two reasons:

  • narrowing of the valve (aortic stenosis) – the aortic valve becomes narrowed and obstructs the blood flowing through it
  • leaking of the valve (aortic regurgitation) – the aortic valve leaks and blood flows back through into the left ventricle

If the aortic valve is no longer working properly, surgery is usually needed to replace it.

Read more about why you might need aortic valve replacement surgery.

How is aortic valve replacement carried out?

During surgery, a cut is made in the chest to access the heart. The heart is then stopped and a heart-lung bypass machine is used to take over the circulation during the operation.

The aortic valve is removed and replaced with an artificial valve (prosthesis). The heart is then started again and the chest incision is closed.

Read more about what happens during aortic valve replacement surgery.

Risks

An aortic valve replacement carries a risk of complications, some of which can be life-threatening. Around 1 in 50 people who undergo this type of surgery die from complications either during or shortly after surgery.

However, if aortic stenosis and aortic regurgitation are not treated, there is a much higher risk of dying from these conditions. However, the benefits of aortic valve replacement will usually far outweigh any associated risk of surgery.

Read more about the risks of aortic valve replacement.

Alternatives to aortic valve replacement

An aortic valve replacement is the most effective treatment for aortic stenosis and aortic regurgitation. Alternative treatment options are usually only used if a person is too frail for open-heart surgery, or using the standard method carries a high risk of complications.

Alternatives to aortic valve replacement include:

  • transcatheter aortic valve implantation – the replacement valve is guided into place through the blood vessels rather than through a large incision in the chest
  • aortic valve balloon valvuloplasty – the valve is widened using a balloon
  • sutureless aortic valve replacement – the valve is not secured using stitches (sutures), to minimise the time spent on a heart-lung machine

How common is aortic valve replacement surgery?

Almost 5,000 aortic valve replacements were carried out on the NHS in England between April 2011 and April 2012.

An aortic valve replacement requires both specialised training and equipment. However, your local hospital may not be able to provide this treatment.

If this is the case, you will be transferred to a hospital that does.

Read more about waiting times and choice in the NHS.

Page last reviewed: 03/04/2014

Next review due: 03/04/2016

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Comments

The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Boleyn15 said on 27 September 2014

I had a homograft replacement in 1995 due to a congenital bicuspid valve. As I was only 30 at the time, I chose this as I didn't relish taking Warfarin at such an early age.
I was very fortunate that this valve lasted me 18 years which is over and above the normal life span.
After yearly checks with my cardiologist I was referred back to St Thomas' to discuss replacement. My brilliant surgeon advised me to go for a mechanical valve, as opening me up for a third time after degeneration of a second homograft would really be pushing my luck.
My fears about Warfarin are totally unfounded. The clicking of my mechanical valve is soothing rather than irritating. I ride my bike 3 times a week, have a glass of vino most nights ( occasionally more than one) and I continue to work as a Paramedic.
I have had the same Cardiologist for 27 years and the same surgeon did both valve replacements.
I feared the build up to my first valve replacement but since then I have had total trust in the fantastic professionals who looked after me, surgeons and nurses and auxiliary staff equally. I'm off work at the moment as a car pulled out in front of my bike and I landed up fracturing my clavicle!!!
If I can give anyone any advice it would just be 'go for it' and let these brilliant people give you your life back.

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HCBS said on 31 August 2014

I also had AVR in May 2005, the process was not scary my surgeon was brilliant - I chose a Bovine valve because I just didn't want Warfarin. I was back at work only 2 weeks later and I haven't had any problems at all until recently and this valve needs replacing again and scheduled for Early October 2014 I will have the same surgeon which I am happy about. My dilemma is choosing a valve, the advice is mechanical ( silicone has never been offered ) and YET I still don't want Warfarin and the complications that might bring, self monitoring won't be so difficult as a Type 1 diabetic However IF I opt for another Bovine valve re-do re-do is not attractive and probably won't be done which would perhaps give me 8-15 years and I will still be working full time and in my early 60's SO ... what to do? I just don't know

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Dave 59 said on 30 April 2014

Hi I had an aortic valve replacement in June 1996 at the BRI ( live in swindon) as I was only 37 at the time they chose the silicone artificial replacement. I am now 54 and I have not suffered any setbacks regarding my heart and have done pretty much what I wanted to do since then regarding work and leisur.

I monitor my own INR and still take Warfarin daily plus some other statins and blood pressure tablets all related to the original congenital condition which whilst it can be a pain its a small price to pay given the alternative.

My only gripe is that I still have to pay for all my medication which is a bit annoying as if i didn't take my medication i.e. Warfarin I would die, and thus given as its still a life threatening condition as a result, would have thought our dear Government would have seen fit to provide this medication FOC same as for diabetes patients?

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EllSam said on 24 March 2014

My wife had a Bovine Pericardial Aortic Valve fitted in January 2006. After just eight years the valve has failed due to SVD (Structural Valve Deterioration). She is suffering with aortic stenosis and aortic regurgitation as the valve is neither opening or closing properly. She is in our local hospital at the moment, having been admitted as an emergency patient following a seizure type incident, waiting for a bed in the nearest cardiac hospital so a second, replacement prosthetic valve can be fitted without unnecessary delay. The Cardiologist she is too ill to be allowed home to await a date. Does she choose bovine again or metal this time? Or, will she get a choice? This is not something we thought we would have to go through again so soon!

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equinas45 said on 19 February 2014

I had aortic Valve surgery in 2009 (bovine). I was diagnosed as "severe" in 2007, but they delayed as long as possible before doing the op. My beef is that the new valve is only 21mm, whereas if it were done in 2007, the valve would have been larger (?), making life much more comfortable now!

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Fionna said on 26 December 2013

Last Wednesday my Mum went into hospital to have a replacement aortic valve, During the operation they discovered that she also had a leaking mitral valve which they had to correct at the same time. Unfortunately due to these complications and some fragments being sent through the artery she suffered a stroke down her right side. Not only that she needs to have a pacemaker fitted, however at the moment her life is in the balance and all that remains is that we pray for her. At the moment I am struggling to come to terms with this as she walked into hospital and friends and family were telling her how well she was looking and seeing her now I cannot believe it I am absolutely devastated.

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gibberinggeoff said on 03 November 2013

I had a valve replacement in Oct 2011 and have had no problems apart from one . My valve is a bovine one and I keep going out and trying to eat the grass on the lawn otherwise O K . Mine was done a Liverpool Heart Hospital and I would rate this hospital the best I have ever been in . I had lost my wife two years before and as anyone who has a very happy marriage knows one of the things we all crave is that comforting hand and hug from your wife when going through major problems , and I was dreading waking to realise she was not there . The staff where well trained to help with this and the would spend hours talking to me about our life together , this was an unbelievable help to a very upset 70 year old who had loved his wife of 41 years , We had a very good marriage as during the 41 years we had never fallen out . The help that the staff gave me will never be forgotten , Thank You Girls You are Simply the Best .

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zetog said on 24 July 2013

I just thought that you would like to know that my husband had a mechanical aortic valve replacement in 1978 at St. Thomas' Yes, it really was 35 years ago! He is now 70years old and still going strong. The only reason I am posting and not him is that he is in the garden putting together our new conservatory, so is somewhat busy. Obviously there has been some problems along the way, mainly with his long term use of warfarin. At the moment he is having difficulty getting an MRI scan (on his prostate not heart) at our new hospital (we have recently moved from Canterbury to Swindon) although he has had about 5 before over the years. I hope that this gives hope to people that these valves do last and allow you to lead a fulfilling life.....

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wivapy said on 09 June 2013

Hi, had a new heart valve replaced as I had Aortic Stenosis, I had a pigs valve inserted, I am 60, I had the operation at the Golden Jubilee hospital in Clydebank, and I cannot thank the entire staff enough. I am a year down the line and I have regained my health, healthier now than I was this time last year.

William Young.

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byhisgrace said on 15 December 2012



Hi Haley,
My name is Frances I am 63 years old and two years ago I had to have open heart surgery. The surgeon had to replace my aortic vale. I chose the vale of a cow because after hearing the mechanical one does not always work too well with some patients.
I was told I had aortic stenosis. I was also in respiratory failure at the time. I also had to go back under surgery to get a pace maker. My doctor told me my heart was beating just 15 o/o at the time I was admitted. It is ony God's grace I am still among the living.

Although, it was two years ago I still find I stay extremely tired. As a result of being in respiratory failure, I am now diagnosed as asthmatic so breathing medications has been added to the list of medications.

Although, the vale had to be replaced I had more energy before the surgery than I do now. It seems everyday is an extreme effort to get moving. Therefore, I make myself move. Pray you are feeling much better!!!

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misswelsh1 said on 10 October 2012

hi, im hayley, im 34. I had open heart surgery 2yrs ago to replace 2 heart valves and patch another 1 . just would like to hear from anyone who have had this operation... thanks

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syrasen said on 21 December 2010

Heart valve surgery is used to repair or replace diseased heart valves. The blood that flows between the various chambers of your heart has to flow through a heart valve. The blood flowing from his heart in the large arteries should undergo a heart valve. These valves open enough so that blood can flow through. They then close, keeping blood from flowing backward. There are four valves in your heart: Aortic, The mitral valve, The tricuspid valve, Pulmonary Valve.
http://www.insideheart.com/aortic-valve-replacement.html

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