Aortic valve surgery

Aortic valve surgery is now a common, safe and effective cardiac procedure to treat serious valve diseases such as aortic stenosis or aortic insufficiency. Replacing the diseased valve with a mechanical or biological valve restores normal blood flow and considerably improves the patient's quality of life.

Thanks to advances in cardiac surgery, techniques are evolving. In addition to the traditional sternotomy method, it is now possible to use minimally invasive approaches, which reduce post-operative pain, speed up recovery and offer better aesthetic results.

What is the aortic valve?

The aortic valve is one of the four valves of the heart. It lies between the left ventricle, the heart's main pumping chamber, and the aorta, the body's largest artery. With each heartbeat, this valve opens to allow oxygen-rich blood to leave the heart and irrigate the organs. It then closes to prevent blood flowing back into the heart. This precise mechanism ensures smooth, efficient circulation. Its role is therefore fundamental: by regulating blood flow in a single direction, the aortic valve protects the heart from overload and ensures adequate oxygenation of the body.

What are aortic valve diseases?

Over time, or as a result of certain conditions, the aortic valve can deteriorate, leading to two main types of disorder: aortic stenosis and aortic insufficiency.
In the case of stenosis, the valve leaflets thicken or calcify, reducing the valve's opening. The passage of blood is then impeded, forcing the heart to pump harder. This phenomenon can remain silent for years before the first signs appear, such as shortness of breath or chest pain. Conversely, aortic insufficiency occurs when the valve no longer closes properly. Blood then flows back to the heart, which has to work harder to compensate for this leakage.
These diseases can result from natural aging, congenital malformations such as the bicuspid valve, or infections such as endocarditis. In Western countries, the most common cause is age-related calcific degeneration.

When is surgery needed?

The decision to undergo surgery depends on a number of criteria, first and foremost the severity of the valve disease and the presence of symptoms. In general, as long as the stenosis or insufficiency is moderate, regular medical supervision is sufficient. But as soon as the valve becomes too narrow or too leaky, and especially when signs such as shortness of breath, chest pain, dizziness or syncope appear, intervention becomes unavoidable.

In some asymptomatic patients with severe stenosis, surgery may also be indicated if echographic criteria or reduced cardiac function are observed. Valve replacement - whether surgical or transcatheter - is currently the only curative treatment for advanced aortic valve disease.

What types of surgery are available?

Today, there are several surgical techniques available to treat aortic valve disease, and the choice of approach depends on a number of factors, including the patient's age, general condition, valve anatomy and any associated conditions.

Replacement surgery

Replacement surgery involves removing the defective valve and replacing it with an artificial one, which may be mechanical (made from synthetic materials such as carbon or steel) or biological (made from animal or human tissue). Mechanical valves have the advantage of being very durable, but require lifelong anticoagulant treatment. Biological valves, on the other hand, are better tolerated, but wear out more quickly.

Valve replacement surgery can be performed either through the opening of the sternum (sternotomy), the most common technique, or through a minimally invasive surgical technique. In the latter, a small horizontal incision is made between the 2nd and 3rd ribs, without opening the sternum. By exploiting the natural space between the ribs, the specialist surgeon can access the valve directly, excise the diseased valve, clean the aortic annulus and implant a new prosthetic valve, just as in conventional surgery. This minimally invasive approach enables faster recovery, requires fewer blood transfusions and confers a much better aesthetic result. This minimally invasive approach is proposed at Hôpital de la Tour.

Aortic valve repair

Another, rarer option is aortic valve repair, which preserves the native valve. This procedure requires very specific surgical expertise, and is intended for well-selected cases, notably isolated aortic insufficiency. This surgery is offered at our hospital.

Valve implantation

Finally, when open-heart surgery presents too many risks, or when the patient is older, less invasive techniques are preferred, such as transcatheter valve implantation (TAVI/TAVR), which is performed by cardiologists rather than surgeons.

Procedure

Once the indication for aortic valve replacement has been made and confirmed, after a detailed examination of each patient's medical file by the Heart Team at Hôpital de la Tour (a committee of specialist cardiologists, cardiac surgeons, anaesthetists and intensivists), the patient is admitted to hospital the day before surgery. He will see the anesthetist, the physician who will draw up his file and his surgeon.
On the day of surgery, the patient is put under general anaesthetic. In most cases, an incision is made in the center of the chest (median sternotomy) to access the heart. The heart is temporarily stopped, and a heart-lung machine takes over for the duration of the operation. The diseased valve is then removed and replaced or repaired, depending on the indication. In minimally invasive surgery, the incision is smaller, sometimes lateral, allowing more targeted access with less trauma.

Once the procedure is complete, the heart is restarted, the incision closed and the patient transferred to intensive care for close monitoring. Hospitalization generally lasts a week, and a rehabilitation program is put in place as soon as the patient is discharged.

Risks and benefits

As with any open-heart procedure, aortic valve surgery carries risks, which vary according to the patient's age and medical history. Possible complications include infections, heart rhythm disorders, bleeding or, more rarely, stroke.

The long-term benefits are considerable. Surgery can relieve symptoms, improve quality of life and prevent serious complications such as heart failure. In the majority of cases, patients return to a normal life, with a prolonged life expectancy. Valve repair, when possible, offers the added advantage of preserving the native valve, thus avoiding long-term anticoagulant treatment.

FAQ on aortic valve surgery

How long does a replaced aortic valve last?

The operating life of a mechanical valve often exceeds 25 years, and can be for life. Biological valves, on the other hand, have a lifespan of 10 to 20 years.

Can I benefit from minimally invasive aortic valve surgery?

Yes, if you have only isolated aortic stenosis or insufficiency, with no other associated cardiac disease. However, a personalized assessment is required to confirm feasibility.

What are the risks of aortic valve surgery?

The main risks are infection, heart rhythm disorders, bleeding or stroke, with a low operative mortality rate in specialized centers (around 1-2%).

How long does it take to recover from aortic valve surgery?

Full recovery usually takes between 1 and 3 months. Patients often benefit from a cardiac rehabilitation program to optimize their recovery.

Who should I see about these symptoms?

We recommend that you see the following health professional(s) :

PD Dr. med.

Aristotelis Panos

Cardiovascular surgeon

Hôpital de La Tour

Specialties involved

Heart surgery