Surgical aortic valve replacement (SAVR) is a surgical procedure performed to replace a damaged aortic valve when it can no longer function properly. The aortic valve serves as the gateway between the heart and the main artery (aorta). Over time, the valve can deteriorate due to factors such as aging, causing it to become narrow or allowing it to leak. This condition is known as aortic valve disease. Initially, it may be asymptomatic, but as it worsens, it places additional strain on the heart, potentially leading to chest pain, breathing difficulties, and even life-threatening complications.
SAVR is a major open-heart surgery that involves making an incision in the chest to access the heart. It is a complex procedure with associated risks and benefits. While it carries some risks, including those typical of surgery, it can significantly improve a patient’s quality of life by alleviating symptoms, protecting the heart, and potentially extending their lifespan. Each individual’s case is unique, and healthcare providers carefully weigh the advantages and disadvantages of SAVR to make informed treatment decisions.
In an open, invasive aortic valve replacement, a surgeon replaces the malfunctioning aortic valve with an artificial one. The aortic valve is one of the heart’s four valves responsible for regulating blood flow. When the valve becomes dysfunctional, an artificial valve is used to restore normal blood flow from the heart to the body. This procedure is termed “open” because it involves a traditional chest incision, which is larger than the incisions used in minimally invasive aortic valve replacement surgeries. The choice of surgical approach depends on the patient’s specific condition and the recommendations of their healthcare team.
There are two main types of valves used in SAVR (surgical aortic valve replacement), and the choice between them depends on various factors. Healthcare providers decide whether to use a biological valve or a mechanical valve, each having its own advantages and disadvantages. Factors like age, personal preferences, and specific medical needs play a crucial role in determining the most suitable valve replacement.
When the aortic valve in the heart isn’t working properly, it can lead to conditions like aortic valve stenosis or aortic valve regurgitation. In some cases, surgery, known as SAVR (surgical aortic valve replacement), may be needed. Here’s what you should know:
When the aortic valve isn’t working as it should, it can cause various symptoms, such as:
It’s important to note that surgery isn’t always recommended for mild cases, and medications may be prescribed to improve heart function. However, in some situations, surgery might be recommended even if symptoms aren’t severe, as it tends to be most effective when done before problems become more advanced.
Surgery inherently carries specific risks, and the extent of these risks can vary among individuals due to their personal medical history, age, and other relevant risk factors. It’s imperative to have open discussions with your doctor to address any concerns you may have.
While open aortic valve replacement generally yields favorable outcomes for most individuals, it is essential to be aware of potential risks, which may include:
Certain factors can elevate the likelihood of experiencing complications. Some of these factors include:
Preparing for surgical aortic valve replacement (SAVR): Before undergoing surgical SAVR, you can expect a thorough pre-surgery assessment from your healthcare team. This comprehensive evaluation involves examining your heart and assessing your overall health to determine the most suitable surgical approach, whether it’s SAVR or the less invasive transcatheter aortic valve replacement (TAVR). The process includes:
When preparing for SAVR, you’ll need to choose between two main types of replacement valves:
Your surgeon will discuss these options with you and recommend the most suitable type based on your age and other health factors. Generally, mechanical valves are preferred for individuals under 50, while bioprosthetic valves are recommended for those over 65. For individuals aged 50 to 65, the choice may depend on personal preferences and medical considerations.
During a surgical aortic valve replacement (SAVR), the procedure involves several key steps. First, the patient is put under deep anesthesia to ensure they feel no pain and have no awareness of the surgery. A heart-lung machine is then connected to the patient, diverting blood away from the heart and lungs. This machine also temporarily stops the heart’s beating using a special solution, allowing the surgeon to work on it safely. The surgeon typically makes a long, vertical incision (sternotomy) in the breastbone, removes the damaged aortic valve, and replaces it with a new one. Finally, the breastbone is reconnected with wires, which usually remain in place for life, and the incision is closed. The entire SAVR surgery typically takes about two to four hours.
In some cases, for specific patients, minimally invasive techniques can be used for aortic valve replacement. These methods, such as partial sternotomy or right anterior thoracotomy, may be considered based on the patient’s individual medical condition and anatomy. If these less invasive options are suitable, the surgeon will provide more information and guidance. These approaches can offer certain benefits, including shorter recovery times and reduced scarring.
Recovery after aortic valve replacement surgery
Remember that the specifics of your recovery may vary, so it’s essential to follow your medical team’s guidance and instructions closely during this process.
Recovery from heart valve surgery typically spans four to eight weeks for most individuals, although those who underwent minimally invasive procedures may require as little as two weeks. The precise duration of your recovery will be determined by your surgeon, who will provide specific guidelines on what to expect and what activities to engage in or avoid during this period. It’s essential to recognize that the recovery process is gradual, and fatigue may persist for several weeks, which is entirely normal as your body requires adequate rest. It’s crucial not to rush the return to your regular routine and instead adhere to your surgeon’s recommendations regarding the safe resumption of your usual activities.
Please contact your healthcare provider immediately if you observe any indications of complications during your post-surgery recovery. Be vigilant for the following warning signals:
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