Aortic Valve Replacement: Minimally Invasive
What is minimally invasive aortic valve replacement?
A minimally invasive aortic valve replacement is a surgery to replace a poorly working
aortic valve with an artificial valve without the need for open heart surgery. The
surgery is called “minimally invasive” because it uses a smaller incision than a traditional
open repair. This may lead to easier and faster recovery from surgery.
The heart has 4 valves. These valves help blood flow through the heart’s 4 chambers
and out to your body by promoting forward flow and preventing backflow. The aortic
valve lies between the left ventricle (the left pumping chamber of the heart) and
the aorta (the blood vessel that carries blood awary from the heart to the rest of
the body). T
Why might I need a minimally invasive aortic valve replacement?
This procedure may be needed if your aortic valve is working poorly. This may happen
if you have aortic valve stenosis or aortic valve regurgitation.
In aortic stenosis, the valve is unable to open fully. This means less blood is able
to exit the heart.
In aortic regurgitation, the valve is leaky. Some blood leaks back through the valve
instead of moving out to the rest of the body.
In both of these cases, you may need to have your aortic valve replaced. A poorly
working aortic valve may lead to symptoms such as:
If these symptoms continue, surgery may be needed. Your healthcare provider may recommend
the surgery even if you don’t have significant symptoms. Surgery is most effective
before symptoms become severe.
Both aortic stenosis and aortic regurgitation can happen because of general aging
of the valve. Other causes of aortic valve disease include:
Heart birth defects (like a bicuspid aortic valve)
Bacterial infection of the heart valve
Tear of the aorta
Aortic aneurysm (weakened, stretched aorta wall)
Certain genetic conditions (like Marfan syndrome)
What are the risks of minimally invasive aortic valve replacement?
There are certain risks with any type of surgery. Your risks will vary based on your
medical condition, your age, and other factors. Be sure to talk with your healthcare
provider about any concerns that you have.
Most people who have minimally invasive aortic valve replacement will have a successful
outcome. However, there are some possible risks. These include:
Irregular heart rhythms, potentially requiring a pacemaker
Blood clots leading to stroke or heart attack
Complications from anesthesia
Certain factors increase the risk for complications. Some of these include:
How do I get ready for a minimally invasive aortic valve replacement?
As you plan for the surgery, you and your healthcare provider will decide what kind
of valve will work best for you. Your surgeon will replace your valve with a biological
valve or a mechanical valve.
Biological valves are made mainly from pig, cow, or human heart tissue. Biological
valves may not last as long as mechanical valves, but the risk for blood clots is
less. As a result, you would not need to take blood thinning medicine.
Mechanical valves are man-made. People with mechanical valves need to take blood-thinning
medicine for the rest of their lives because these valves increase the risk for blood
clots. Mechanical valves also increase the risk for infection.
Talk with your healthcare provider about how to prepare for your upcoming surgery.
Remember the following:
Follow any directions you are given for not eating or drinking before surgery.
Try to stop smoking before your operation. Ask your healthcare provider for ways to
Ask your provider if you need to stop taking certain medicines before your surgery.
Tell your healthcare provider if you usually take blood-thinning medicines like warfarin
or aspirin. Follow your healthcare provider's instructions about which medicines should
be stopped before surgery, and when, as well as which medicines should be continued.
Follow your healthcare provider's instructions about when to come to the hospital
before your surgery. Talk with your healthcare provider and ask any questions you
have about the procedure.
You may also need some routine tests before the procedure to assess your health .
These may include:
A short time before the operation, someone may give you medicines to help you relax.
In most cases, your surgery will proceed as planned. However, sometimes another emergency
might delay your operation.
What happens during a minimally invasive aortic valve replacement?
Check with your healthcare provider about the details of your procedure. In general,
during your minimally invasive aortic valve replacement:
An healthcare provider will give you anesthesia before the surgery starts. This will
cause you to sleep deeply and painlessly during the operation. Afterwards you won’t
The operation will take several hours. Family and friends should stay in the waiting
room, so the surgeon can update them.
Several different approaches may be used in minimally invasive aortic valve replacement.
These can include a small incision through your breastbone, to the right of your breastbone,
or between the ribs on your side. Sometimes surgeons use special instruments and a
camera to do the surgery. With this approach, your surgeon will make several small
holes in your chest. Some surgeons use robot-controlled arms to do the surgery. Your
healthcare provider will review all of your options with you along with their risks
During the procedure, the surgery team will connect you to a heart-lung machine. This
machine will act as your heart and lungs during the procedure.
Your surgeon will remove your current aortic heart valve and replace it with a new
Your heart will gradually be allowed to take over the work of circulation. The surgery
team will remove you from the heart-lung machine.
The team will then sew or staple the incision in your skin in back together.
What happens after a minimally invasive aortic valve replacement?
In the hospital
You will start your recovery in the ICU (intensive care unit) or a recovery room.
When you wake up, you might feel confused at first. You might wake up a couple of
hours after the surgery, or a little later.
Most people notice relief of their symptoms right after surgery.
The team will carefully monitor your vital signs, such as your heart rate. You may
be hooked up to several machines so the nurses can check these more easily.
You may have a tube in your throat to help you breathe. This may be uncomfortable,
and you won’t be able to talk. The tube is usually removed within 24 hours.
You may have a chest tube to drain excess fluid from your chest.
You may have small temporary pacemaker wires coming from your chest.
Bandages will cover your incision. These can usually come off within a couple of days.
You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you
can ask for pain medicine.
Soon after surgery, you will likely be encouraged to get up and sit in a chair. In
a day or two, you should be able to walk with help.
You may perform breathing therapy to help remove fluids that collect in your lungs
You will probably be able to drink liquids once the breathing tube is removed, usually
the day after surgery. You can have regular foods as soon as you feel ready to eat.
You may need to wear elastic stockings or compression devices on your legs to help
blood circulate through your leg veins.
You will probably need to stay in the hospital for several days, but this may vary
from patient to patient.
Make sure you have someone to drive you home from the hospital. You will also need
some help at home for a while.
Be sure to keep all follow-up appointments. You probably will have your stitches or
staples removed in a follow-up appointment in 7 to 10 days.
Be aware that you may tire easily after the surgery, but you will gradually start
to recover your strength. Recovery time after minimally invasive valve surgery tends
to be less than for an open aortic valve replacement.
After you go home, take your temperature and weigh yourself every day. Tell your healthcare
provider if your temperature is over 100.4°F (38°C) or as advised, or if your weight
Call your healthcare provider if you have shortness of breath or swelling in your
Ask your healthcare provider about when it is safe for you to drive.
Avoid lifting anything heavy for several weeks. Ask your healthcare provider about
what is safe for you to lift.
Follow all the instructions your healthcare provider gives you for medicine, exercise,
diet, and wound care.
Make sure all your dentists and other healthcare providers know about your medical
history. You may need to take antibiotics before certain medical and dental procedures
to prevent getting an infection on your replacement valve.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure and who will do it
Who will do the test or procedure and what that person's qualifications are
What would happen if you didn't have the test or procedure
Any alternative tests or procedures to think about
How long it will take to get the results
When and how you will get the results
Who to call after the test or procedure if you questions or problems or an emergency
How much you will have to pay for the test or procedure