Surgical Aortic Valve Replacement - Let's talk about this simply

When your doctor tells you that you need to have surgery to replace your aortic valve because it is not working properly, you may feel a little scared and nervous. That is very normal. But this is a surgery that many people have and has successful results. So today, let's talk about this surgery, namely Surgical Aortic Valve Replacement (SAVR), in a very simple way that will clear up all your doubts.

What exactly is aortic valve replacement surgery (SAVR)?

Simply put, SAVR is when the aortic valve in your heart is so damaged that it no longer works properly, and a new valve is surgically implanted in its place.

Imagine that the aortic valve is the 'door' where the main blood vessel in your body (which we call the aorta) connects to your heart. Every time your heart beats, this door opens and pumps blood into your body. Then, the door closes.

Sometimes, due to age or other reasons, problems can arise with this door.

• Doors not opening properly: Like a rusty door hinge, this valve may not open completely. In medical terms, this is called aortic stenosis . Then, even though the heart beats, not enough blood is pumped out to the body.
• The door doesn't close properly: Just like an old wooden door that won't close properly, this valve can fail to close completely. This is called aortic regurgitation . This causes some of the blood pumped into the body to leak back into the heart.

When a valve malfunctions, your heart has to work harder than usual to pump the blood your body needs. It's like a water pump struggling to pump water through a clogged pipe. This extra effort can damage your heart over time. You may also experience symptoms like chest pain and difficulty breathing. If left untreated, this condition can become life-threatening over time.

SAVR is an open surgery. This means that the surgeon makes an incision in your chest to access your heart. Since this is a major surgery, there are some risks. However, your doctor will clearly explain to you the benefits and risks of this surgery based on your situation.

What happens before the surgery?

You will need to undergo several tests before the surgery. This will help your healthcare team thoroughly evaluate your heart condition and decide which surgery is best for you. For example, they will decide whether SAVR surgery or a smaller incision called TAVR is best for you.

Here are some tests you might want to consider:

• Cardiac Catheterization
• Chest X-ray
• CT Scan
• Echocardiogram (Echocardiogram - Echo)
• An ECG (Electrocardiogram - EKG)
• Blood and urine tests

All of this is done to make sure you are fully prepared for the surgery and that your body can handle it. After that, you will be given a clear set of instructions on how to prepare for the day of surgery.

• How long before surgery should I stop eating and drinking?
• Do you need to temporarily stop any of the medications you are currently taking?
• It's time to come to the hospital.
• What to bring when you come to the hospital and what to leave at home.

If there is anything unclear about these instructions, don't hesitate to ask your doctor or nurse. If you are a smoker, quitting as soon as possible before surgery can greatly reduce your risk of complications.

Choosing a transplant valve: What are the options?

One of the most important decisions you will make when preparing for SAVR surgery is what type of valve you will have implanted. There are two main types of valves. Let's take a look at the pros and cons of each to help you understand them better.

Your surgeon will discuss both options with you and recommend the valve that is best for you based on your age, health, and lifestyle. Typically, a mechanical valve is recommended for people under 50, and a biological valve is recommended for people over 65. For those in between, you can choose either one based on your preferences and needs.

What happens during the surgery?

SAVR surgery usually takes about two to four hours. You will not feel anything during this time. The steps involved in the surgery are simply as follows:

1. Anesthesia: First, your care team will give you anesthesia. This will put you into a deep sleep. You will not feel any pain during the surgery or remember anything that is happening.

2. Connecting to a heart-lung machine: Next, you will be connected to a heart-lung machine. This means that your blood does not go to your heart and lungs during surgery, but instead goes through this machine, where it is cleaned and returned to your body. This is like giving your heart and lungs a little break. This machine also temporarily stops your heart. This allows the surgeon to safely perform the surgery on a non-beating heart.

3. Incision: The surgeon makes a vertical incision (sternotomy) about 6 inches long in the middle of your chest, along the breastbone.

4. Valve replacement: Next, the old, damaged aortic valve is removed, replaced with a new valve and sewn tightly.

5. Chest closure: Next, the two separated parts of the sternum are reconnected using wires. These wires are usually left in place for life. Finally, the skin incision is stitched closed.

Minimally invasive options

In some cases, doctors perform this surgery using smaller incisions. Your doctor will tell you more about whether this is right for you.

What happens after the surgery? How is the recovery time?

After the surgery, you will need to stay in the hospital for about five days. During this time, the medical team will monitor your well-being. They will help you get used to walking a little bit each day and getting back to your normal activities.

It can take four to eight weeks to fully recover after you go home. It's normal to feel tired during this time. Your body needs rest. So don't rush back to your old activities. Follow your doctor's instructions exactly.

Once you are fully recovered (after 6-8 weeks), your doctor may recommend that you undergo cardiac rehab. This is a supervised program that helps you gradually and safely return to exercise. You will also be given guidance on lifestyle changes, such as following a heart-healthy diet and quitting smoking.

What are the benefits, risks, and success rates of this surgery?

Replacing a malfunctioning valve can be life-saving. This condition can be fatal if left untreated.

For most people, the risk of serious complications such as death or stroke is very low. That's as low as 1% to 2%. This risk can vary depending on factors such as your age and overall health. Your doctor will explain your personal risk level to you.

As with any surgery, there can be some complications.

• Heartbeat irregularities (Arrhythmia)
• Needing to have a permanent pacemaker implanted
• Bleeding
• Infections
• Stroke
• Death

These risks are not the same for everyone. They vary depending on your age and other medical conditions. Your doctor will do everything he can to minimize these risks.

When should you talk to the doctor?

While you are recovering at home, it is very important to notify your doctor immediately if you develop any risk symptoms. Be especially aware of the following symptoms:

It's normal to feel scared when you find out that you need to replace a heart valve. But remember, this is a procedure that helps your heart, like repairing something that's broken in your home. After this surgery, your heart will be able to work more easily, and you'll feel better. If you have any questions about this, don't hesitate to talk to your doctor and put your mind at ease.