The aortic valve may become insufficient or narrowed over the years; surgical aortic valve replacement can be performed in Turkey to prevent serious complications that may otherwise lead to death.
About surgical aortic valve replacement
The aortic valve is one of the four heart valves that regulate blood flow in one direction. When the aortic valve opens, blood moves from the left ventricle to the aorta, and when it closes, it prevents blood from flowing backward into the heart—this cycle occurs with every heartbeat.
The valve can become diseased or damaged due to various reasons, impairing its function. When aortic valve repair isn’t feasible, doctors may recommend surgical aortic valve replacement (SAVR) as a definitive treatment.
Surgical aortic valve replacement involves removing the faulty valve and replacing it with either a mechanical or biological one derived from animal or human tissue, which restores normal valve function and prevents backflow of blood.
The success rate of surgical aortic valve replacement is high, with a mortality risk between 1% and 3%. Studies report a survival rate of approximately 94% at five years and 84% at ten years post-operation.
Research confirms the benefits of aortic valve replacement in improving both survival and quality of life in patients with aortic valve stenosis or insufficiency.
Although minimally invasive approaches such as catheter-based or laparoscopic techniques are available for select patients, surgical aortic valve replacement remains the most effective and widely recommended treatment in many cases.
Reasons for surgical aortic valve replacement
An aortic valve issue may occur due to a congenital birth defect, exposure to several factors over the years, or other heart conditions such as septic endocarditis.
All of these causes can lead to one of two conditions:
- Aortic valve stenosis, a condition in which the aortic valve is unable to open fully and the valve opening becomes narrow, resulting in a decrease in the amount of blood leaving the heart.
- Aortic valve regurgitation, a condition in which the aortic valve is unable to close properly, causing blood to return to the heart and flow in the opposite direction.
These issues can cause respiratory distress, chest pain, fatigue, dizziness, fainting, edema in the feet, and other symptoms that can be life-threatening, such as heart failure, if the aortic valve is not replaced as soon as possible.
The doctor may recommend aortic valve replacement even if the patient does not have severe symptoms because the procedure is more effective if the symptoms are not advanced.
Symptoms and signs of aortic valve damage
Patients may not notice disease or damage to the aortic valve for several years, and may visit a cardiologist’s office with one of the following symptoms:
- Chest pain that eases at rest
- Dizziness
- Fainting
- Lethargy or fatigue after exercise
- Respiratory distress after vigorous activity or when lying down
- Irregular heartbeat
- Not eating enough (especially in children with aortic valve stenosis)
Methods for diagnosing aortic valve disease
To diagnose aortic valve disease, the doctor takes a clinical history from the patient by asking them about their symptoms and medical history, then starts by examining the heart and listening to its sounds with a stethoscope.
There are several tests that are used to detect aortic valve disease, including:
- Echocardiography: A technique that uses ultrasound to visualize the heart cavity during beating to reveal the condition of the aorta and aortic valve, and helps determine the cause and severity of valvular lesions, which is the most important diagnostic tool for aortic valve disease.
- Electrocardiogram: A technique that records the electrical activity of the heart, which is used to detect heart failure caused by aortic valve stenosis.
- Plain chest X-ray: Used to view the heart and lungs to detect cardiac enlargement, which may be a sign of valvular disease or heart failure, as well as calcifications in the valve.
- Intensity test: In this test, the patient connected to the ECG machine walks on a treadmill or rides a stationary bike to increase the heart rate. This test helps to see the heart’s reaction to physical activity and detect symptoms of valvular damage during exercise.
- Cardiac catheterization: It is not usually performed to detect aortic valve disease, but it may help determine the severity of the lesion and diagnose the condition if other tests fail to do so, and it also gives information about blood flow and overall heart health, some therapeutic procedures can also be performed by cardiac catheterization.
- MRI: A technique that uses magnetized fluids and radio waves to give a detailed picture of the heart, determine the severity of aortic valve damage, and measure the size of the aorta.
- CT scan: A technique that uses X-rays to produce cross-sectional images of the heart.
Risks of open surgical aortic valve replacement
There are certain risks with any surgery, and these risks vary from patient to patient depending on general health status, age, and other factors, but most patients who undergo aortic valve replacement surgery have had successful and satisfactory outcomes.
Complications of aortic valve replacement usually include the following:
- Sepsis
- Bleeding
- Arrhythmias (irregular heartbeat)
- Kidney issues may persist for a few days after the procedure
- Blood clots leading to stroke or heart attack
- Complications from anesthesia
Some factors increase the risk of complications and the risk of aortic valve replacement surgery in general:
- Chronic diseases
- Other heart conditions or diseases
- Pulmonary Problems
- Aging
- Obesity and overweight
- Smoking
- Infections
Aortic valve alternatives
There are two main types of alternative aortic valves:
- Artificial valves: They are valves made of carbon, metal or plastic, they last long but increase the risk of blood clots, so the patient must take blood thinners for the rest of his life, the doctor will adjust the amount of blood thinners because a little does not prevent the formation of clots and too much may cause severe bleeding after any minor wound.
- Biological valves: These are valves taken from animals or human cadavers, which only last for 12-15 years but do not lead to blood clots and do not need to take blood-thinning medications.
Doctors at Bimaristan Medical Center will explain the benefits and disadvantages of each type of replacement valve and recommend the best option for each patient.
Preparing for aortic valve replacement
The patient will undergo some tests to ensure their health and ability to undergo the procedure, such as:
- Blood and urine tests
- A simple chest image
- Electrocardiogram (ECG)
- Clinical examination
The doctor must be informed of all medications and supplements that the patient is taking, and the doctor may recommend stopping some medications some time before the operation. The patient must stop smoking for two weeks before the operation if he is a smoker to prevent respiratory issues and the formation of blood clots.
The doctor should also be informed if the patient has any illness, even if it is just a mild cold, as this will affect the healing process.
The patient may need to bathe with a special germ-killing soap the night before the procedure, and in most cases, the patient will not be allowed to eat or drink after midnight.
How to perform surgical aortic valve replacement in Turkey
The most common method of surgical aortic valve replacement is open-heart surgery, which typically takes two to four hours and is performed under general anesthesia—ensuring the patient is completely asleep and feels no pain during the procedure.
Surgical aortic valve replacement in Turkey is carried out through the following steps:
- The surgeon creates an 8–10 inch (20–25 cm) vertical incision down the center of the chest, through the sternum, to access the heart.
- The heart is connected to a cardiopulmonary bypass machine, which temporarily takes over the heart and lung function, allowing the surgeon to safely stop the heart.
- The damaged aortic valve is then removed and replaced with a new mechanical or biological valve.
- Once the valve is secured, the heart is restarted, and the bypass machine is removed.
- Finally, the surgeon reattaches the sternum and closes the chest incision.
After the surgical aortic valve replacement, the patient is transferred to the intensive care unit for close monitoring and to manage any potential complications.
Ross procedure
This form of surgical aortic valve replacement is typically performed in patients under the age of 40 or 50, especially if they prefer to avoid taking blood-thinning medications for life.
In the Ross procedure, a specialized type of surgical aortic valve replacement, the patient’s own pulmonary valve is used to replace the damaged aortic valve due to the similarity in their anatomical structures. The pulmonary valve is then replaced with a pulmonary graft taken from a donor heart, which is preserved and frozen until the time of surgery.
The use of a pulmonary graft to replace the pulmonary valve—rather than the aortic valve—is strategic, as blood flows at a lower pressure through the pulmonary valve, allowing the graft to last longer when used in that position.
This type of surgical aortic valve replacement carries a lower risk of blood clots and valve infections compared to mechanical replacements, making it a durable, long-term solution for aortic valve disease.
However, the Ross procedure is complex and lengthy, as it involves work on two heart valves, and is therefore reserved for younger patients who can safely endure extended surgery.
Recovery after aortic valve replacement surgery
After a surgical aortic valve replacement, the patient typically needs to stay in the hospital for about a week. However, full recovery may take two to three months depending on factors such as the patient’s age, overall health, and the specific type of surgical aortic valve replacement performed.
Most patients feel noticeably better soon after the procedure and can gradually resume daily activities once they return home, often experiencing continuous improvement each day. To support recovery, doctors may recommend light exercise or participation in a cardiac rehabilitation program.
Patients may require 6 to 8 weeks before they can return to office work, and typically are advised not to drive for 4 to 6 weeks after the surgical aortic valve replacement, depending on healing progress and medical advice.
Always consult your doctor about which activities are safe to resume and which should be avoided until recovery is complete.
Other methods for aortic valve replacement
In some cases, surgical aortic valve replacement is performed using minimally invasive laparoscopic techniques, which involve a smaller incision and avoid cutting through the sternum.
A TAVR aortic valve replacement may be performed by making an incision in the groin and inserting the replacement valve through the femoral artery, guiding it to the aortic valve site using a catheter.
While these approaches are typically less painful and result in shorter hospital stays, minimally invasive procedures are not suitable for all patients and are generally recommended only when open-heart surgical aortic valve replacement is not an option.
Ultimately, the doctor will determine the most appropriate procedure based on the expected outcomes and level of risk for the patient.
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