Your surgeon will perform an aortic valve replacement if your aortic valve is not functioning properly. The heart is a muscular organ that pumps blood through the body. It consists of four chambers. The upper chambers are the right and left atria. The lower chambers are the right and left ventricles. The right and left atria connect to their respective ventricles. The right ventricle connects to the pulmonary artery, and the left ventricle to the aorta. Valves are located at these connections to ensure that blood moves in only one direction. The parts of a valve that open and close are flaps of tissue called cusps. The aortic valve is located between the left ventricle and the aorta. When the heart contracts, the aortic valve opens and blood is pumped into the aorta. When the heart relaxes, it closes to prevent blood from leaking back into the left ventricle. A normal aortic valve has three smooth cusps that open widely and close tightly. Your aortic valve may be leaky or narrowed, causing your heart to work harder and disrupt your blood flow. A leaky valve does not close all the way, causing blood to leak back into the ventricle between each heartbeat. This condition is called aortic regurgitation.
A narrowed aortic valve does not open all the way, which restricts the amount of blood passing out of the ventricle into the aorta. This condition is called aortic stenosis. You may have been born with an abnormal aortic valve. For example, your aortic valve may only have two cusps instead of three, so it may not open and close properly. Your aortic valve may have become damaged during your lifetime, a condition called acquired aortic valve disease. Causes include rheumatic fever, which can be a complication of untreated strep throat; endocarditis, which is a bacterial infection of the valve; and sclerosis, or hardening of the aortic leaflets. After a period of time, a faulty aortic valve can cause the heart muscles to become enlarged and weakened. Depending on the nature of the valves defect, the walls of the left ventricle may become abnormally thick or thin, and the problem can eventually affect the right side of the heart as well. Patients with this condition, known as heart failure, may experience shortness of breath; chest pain, or angina pectoris; dizziness, lightheadedness, and/or fainting; swelling of the ankles, feet, and legs; and fatigue. An aortic valve replacement is performed to restore the valve to normal function. Before your procedure, an IV line will be started in your arm to provide fluids and medications.
A catheter will be inserted into your bladder to drain urine. Aortic valve replacements are done under general anesthesia. This means you will be asleep for the duration of the operation, and a tube will be placed through your mouth and into your windpipe to help you breath during surgery. Once the anesthesia takes effect, your surgeon will begin by making an incision in the chest. The traditional incision is made in the middle of the chest overlying the breastbone, or sternum. The surgeon then separates the sternum to expose the pericardium, which is a protective membrane encircling the heart. Your surgeon will then open the pericardium to expose the heart. At this point, your heart will be connected to a heart-lung machine. Tubes are used to reroute your blood into this machine, which takes over the functions of the heart and lungs during the operation. Once the heart-lung machine has taken over, your heart will be temporarily stopped & the blood inside removed. This keeps the aortic valve still & allows your surgeon to see it. Your surgeon will open the aorta to expose the aortic valve, make an incision around the edge of the damaged valve, & remove it. Your surgeon will then carefully sew the replacement valve into place & close the aorta with stitches. At this point, blood will again be allowed to flow into your heart to check the function of the new valve. If needed, an electric shock will be given to restart the heart. Once your heart is beating on its own, it will be detached from the heart-lung machine. Generally, temporary pacemaker wires will placed on the surface of the heart to ensure the heart maintains a normal rhythm during recovery. After surgery, you'll be taken to the intensive care unit where your vital functions will be monitored. You will still have a breathing tube in your throat, which will prevent you from talking. Several tubes will be in place to drain blood & fluid from your incision, & your bladder catheter will still be draining your urine.
