Surgery involves opening the chest through the breast bone and taking over the function of the heart and lungs with a machine (“heart bypass”) to allow the surgeon to stop the heart, and replace the damaged valve. At the end of the operation drains are placed into the chest. Once the operation is completed the heart bypass machine is turned down and your own heart starts beating by itself. Once the surgeon is happy with your progress the heart bypass machine is removed. The final stage of the operation is to close the chest. Your breast bone is held together with about stainless steel wires and the muscle and skin are stitched. Pacing wires are placed on the surface of the heart in case of a low heart rate (bradycardia) in the early post-operative stage. The chest drains are usually removed within 24-36 hours, and the pacing wires after about 4-5 days.
There are 2 types of valve which are commonly used:
Tissue Aortic Valve Replacement — engineered from a pig or cow heart valve. Their main advantage is that you would usually not need to take Warfarin afterwards. For women contemplating having a family, this can be very important due to the side-effects of the medication and effects on an unborn child.
Metal Aortic Valve Replacement — this is a metal valve. You would need to take Warfarin tablets for life afterwards. The main advantage of having a metal valve replacement is that it should last for many, many years, possibly even forever.
Aortic root replacement is the treatment for an enlarged aorta. In aortic root replacement the surgeon removes the enlarged section of the aorta and replaces it with an artificial tube (Dacron graft).The coronary arteries (blood vessels that supply the heart with oxygen rich blood) are attached to the aorta. These are removed during the operation and re-implanted once the new graft is in place. In some cases the aortic root and aortic valve both need replacing at the same time. One technique is where the surgeon sutures the valve inside of the graft. Risk factors associated with this type of procedure will be discussed with you in the surgical clinic.
The procedure is very safe with a risk of dying of around 1 in 100. There is an even smaller risk of brain damage (stroke) related to the use of the heart bypass machine. Other minor problems can occur, such as bleeding, infection, fluid collecting around the heart or temporary electrical instability but these are rarely serious. After surgery a short stay on the intensive care unit (usually 2 days) and then a period in hospital for observation (usually about 7 days) is required before going home. Opening the front of the chest leads to a scar and the chest wall will be sore whilst it heals. The time taken to get fully back to normal varies from person to person but can be up to 3 months.