Aortic valve replacement

Page last reviewed: 13/07/2011

Aortic valve replacement is a type of open heart surgery to treat problems affecting the aortic valve in the heart.

During surgery, an incision (cut) is made in the chest to access the heart. The heart is then stopped and a heart-lung (bypass) machine is used to take over the circulation during surgery. The aortic valve is removed and replaced with a prosthesis (a man-made valve). The heart is then started again and the incision in the chest is closed.

The heart

The heart has four chambers. There are two small chambers at the top of the heart called atria, and two larger chambers at the bottom which are called ventricles. Each ventricle has two one-way valves:

  • one valve controls the blood flowing into the ventricle, and
  • the other valve controls the blood flowing out of the ventricle.

Each valve is made up of flaps (also called leaflets, or cusps) that open and close, acting as one-way gates for the blood to flow through.

What is the aortic valve?

The aortic valve is the valve that controls the flow of blood out of the left ventricle of the heart, to the aorta (the body's main artery). From the aorta, the blood flows to the rest of the body.

The aortic valve opens to allow blood to flow from the heart out to the rest of your body. It then closes to stop any blood leaking back into the heart.

Aortic valve replacement

There are two reasons that the aortic valve may need to be replaced:

  • stenosis (narrowing) - if the aortic valve becomes narrowed and obstructs the blood flowing through it, or
  • regurgitation (leaking) -  if the aortic valve leaks and blood flows back through the it into the left ventricle. This is also known as incompetence or a leaking valve.

If the aortic valve is no longer working properly, an aortic valve replacement is the usual method of treatment and is a highly successful one.

Incision
An incision is a cut made in the body with a surgical instrument during an operation.

Bypass
A bypass is when the flow of blood or other fluid is redirected, permanently because of a blockage in the body, or temporarily during an operation.

Page last reviewed: 13/07/2011

Aortic valve replacement is necessary if your aortic valve is either:

  • stenosed (narrowed), or
  • regurgitating (leaking).

There are several diseases that can cause stenosis or regurgitation in your aortic valve. These can either be:

  • congenital aortic valve diseases - a defect you were born with which may not cause a problem until you are older, or
  • acquired (or degenerative) aortic valve diseases - a defect that has built up over the years.

Some possibilities are explained below.

A bicuspid aortic valve

A bicuspid aortic valve is the most common type of congenital aortic valve disease, affecting 1-2% of people. It occurs when the aortic valve only has two flaps (which act as gates to allow blood through) instead of the usual three. The valve may function normally for years without you being aware of the problem, often until you reach your 50s or 60s.

Senile aortic calcification

Senile aortic calcification is the most common cause of aortic valve disease. It is a degenerative disease, which means that it occurs as a result of ageing. Calcium deposits form on the valve, preventing it from opening and closing properly. In this case, you are most likely to be diagnosed with valve problems when you are in your 70s or 80s.

Diseases of the aorta

Diseases of the aorta are rare, but they can cause problems for the aortic valve. For example, Marfan syndrome is an inherited condition that affects the blood vessels and can cause aortic aneurysms (when the blood pressure causes the blood vessel to bulge and possibly rupture). 

Symptoms

Sometimes, if you have a problem with your aortic valve, you may not experience any symptoms until quite late on in the disease. Any symptoms that you do feel occur because your heart is unable to pump blood around your body efficiently. Symptoms that you may experience include:

  • chest pain (angina) - this is caused by your heart having to work harder due to the restricted blood flow through your aortic valve,
  • shortness of breath - at first you may notice this only when you exercise, but later you may experience this even when resting,
  • dizziness or light-headiness - this is caused by the obstruction of the flow of blood from your heart to the rest of your body, and
  • loss of consciousness (fainting) - this is also a result of reduced blood flow caused by the obstruction in your heart. 

Surgery may necessary

If your GP suspects you have aortic valve problems, they will refer you to a heart specialist (cardiologist) to do some tests (see the box, left).

If you only have a mild disease, you will be invited to come in for an echocardiogram every year or two to check whether the problem is getting worse. If you have moderate to severe disease, you will be referred to a heart surgeon.

In some cases, you may not have any symptoms, but surgery will be necessary to prevent irreversible damage being done to your heart.

Without treatment the condition will worsen

The stenosis or regurgitation of your aortic valve is likely to get worse without treatment. This is because your left ventricle has to work increasingly harder to pump blood into your aorta (this is called progressive ventricular dysfunction). This uses up more energy and requires more blood. It will cause increasing pain (angina) and will eventually lead to heart failure.

Aorta
The aorta is a large blood vessel that runs down the abdomen and transports blood away from the heart.

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

Ultrasound scan
An ultrasound scan, sometimes called a sonogram, is a procedure that uses high frequency sound waves to create an image of part of the inside of the body, such as the heart.

What tests will I have?

Some possible tests are described below.

Echocardiogram

An echocardiogram is where an ultrasound scan  is used to produce an image of your heart. The test can identify the structure, thickness, and movement of each heart valve. There are two main kinds of echocardiogram:

Transthoracic echocardiogram

During a transthoracic echocardiogram, a gel is spread over your chest and a device called a transducer is passed over your skin. A transducer is a microphone-shaped device that can transmit and receive information. In this case, it converts the echoes from the ultrasound waves into electrical impulses. The electrical impulses are then converted into moving images that can be seen on a television screen.

Transoesophageal echocardiogram

During a transoesophageal echocardiogram, a small transducer (in this case, like a piece of wire inside a thin flexible tube) is guided into your oesophagus (gullet). The transducer can send ultrasound waves into the heart, and then convert the echoes into an image. This technique may be used if it has not been possible to get a clear view of your valves using a transthoracic echocardiogram. It can also be used to give the surgeon a more accurate picture of your valve anatomy, which can be useful for planning surgery.

Coronary angiography

Coronary angiography is also known as coronary arteriography, or cardiac catheterisation. A catheter (a thin tube) is passed into a vein or artery, either in your groin or arm. X-ray is used to guide the tip of the catheter to your heart, or to the arteries that supply the heart.

Once in position, a special fluid (called contrast medium, or dye) is injected. The dye is visible on an X-ray, which allows pictures (angiograms) of your blood vessels, or heart chambers, to be produced.

Page last reviewed: 13/07/2011

Pre-admission clinic

Before having an aortic valve replacement, you will attend a pre-admission clinic where you will be seen by a member of the team who will be looking after you in hospital.

At the clinic, you will have a physical examination and be asked for details of your medical history. Any investigations and tests that you need will be arranged, for example, a blood test or an X-ray. This is a good time to ask questions about the procedure, although you can discuss your concerns with your doctor at any time.

You will be asked if you are taking any tablets or other types of medication. These might be prescribed by your GP, or bought over-the-counter (OTC) in a pharmacy. It helps if you bring details with you about any medication that you are taking - for example, by bringing the packaging with you.

You will be asked about any previous anaesthetics (painkilling medication) that you have had, and whether you had any problems or side effects with these, such as nausea. You will also be asked whether you are allergic to anything in order to stop you having an allergic reaction to any medication that you might need.

You will be asked about your teeth, including whether you wear dentures, have caps, or a plate. This is because during the operation you will need to have a breathing tube inserted into your throat to help you breathe, and having loose teeth could be dangerous.

Preparing for hospital

Before you go into hospital for your operation, you may find the following checklist useful.

  • Do your homework - find out as much as you can about what is involved in your operation. Your hospital may provide written information or have a video about the procedure. You can also ask your doctor any questions that you have.  
  • Ask your GP to check that any other medical problems are under control, such as high blood pressure (hypertension).
  • Arrange transport - arrange for someone, such as a friend or relative, to take you to and from the hospital, or book a taxi.
  • Prepare your home - before going into hospital for your operation, put items such as your television remote control, radio, telephone, medications, tissues, address book, and a glass on a table next to where you will spend most of your time when you return home.
  • Stock up - get in a stock of food that is easy to prepare, such as frozen ready meals, tin foods, and staples, such as rice and pasta. You could also prepare your own dishes and freeze them so that you can use them during your recovery.
  • Clean up - before going into hospital, take bath, or shower, wash your hair, and cut your nails. Also, put on freshly washed clothes. This will prevent you taking unwanted bacteria into hospital with you which could complicate your care.
  • Arrange help - ask a friend, or relative, to help you at home for a week or two after you come out of hospital.
  • Check the hospital's advice about taking the pill, or hormone replacement therapy (HRT) - if you are advised to carry on taking these, make sure that you have some with you at the hospital and some at home.
  • Check whether you can eat anything before your operation - most anaesthetics are safer if your stomach is empty, so you will normally have to stop eating several hours before your operation. This should be made clear during your pre-admission checks.

Preparing for treatment

Your surgeon will discuss how you should prepare for treatment with you. Their advice may include:

  • Stop smoking - smoking increases your risk of developing a chest infection and can delay healing, as well as increasing your risk of getting blood clots.
  • Watch your weight - if you are overweight, your surgeon will usually advise you to lose weight. As strenuous exercise could be dangerous, you will need to do this by dieting. Your GP will be able to advise you about the best way to lose weight.
  • After your operation, exercise gently - staying active can help your recovery, but it is important not to overdo it. Light walking on flat ground should be fine. Your GP, or heart surgeon, will be able to advise you about how much you can safely do.
  • Think positive - a positive mental outlook can help you to deal with the stress of surgery and aid your recovery.
  • See your dentist - having healthy teeth and gums reduces your risk of infection. Bacteria from decayed teeth, or gum disease, can introduce bacteria into the bloodstream, which can cause complications after your operation.

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

X-ray
An X-ray is an imaging technique that uses high-energy radiation to show up abnormalities in bones and certain body tissue, such as breast tissue.

Nausea
Nausea is when you feel like you are going to be sick.

What should I take into hospital?

  • A change of nightclothes.
  • Something comfortable to wear.
  • A pair of slippers.
  • A dressing gown.
  • Personal toiletries, such as your toothbrush and flannel.
  • Any medications that you are taking, including details about any treatment that you are currently receiving. 
  • Any equipment that you use, such as a walking stick, or hearing aid.
  • Books, iPod, stationery, jigsaws, crossword books, and other things to help pass the time during your recovery.
  • Your address book and important phone numbers.
  • Some money so that you can use the telephone (you can take your mobile phone, but you may not be able to use it on the ward).
  • Hospitals can now accommodate most kinds of diet, including religious requirements, athough you may wish to take a few healthy snacks with you for between meals.

Page last reviewed: 13/07/2011

There are different ways that an aortic valve replacement can be performed. If you wish, your surgeon will be able to explain the procedure to you in more detail. Some of the steps are described below.

Making an incision

Your surgeon will make an incision (cut) in the front of your chest, before cutting lengthways down the middle of your breastbone (sternum) for about 25cm (10in). This is called sternotomy.

Heart-lung machine

Tubes will be inserted into your heart and major blood vessels, and they will be attached to a heart-lung (bypass) machine. When the heart-lung machine is turned on, your blood will be diverted into the machine instead of into your heart. The machine will pump oxygen-rich blood around your body until the operation is complete, taking over the role of your heart and lungs.  

Your heart will be stopped by filling the coronary arteries (the blood vessels that supply your heart with blood) with a chemical solution. Your aorta (the body's main artery) will be clamped shut, so that your surgeon can open your heart and operate on it without blood pumping through it.

Replacing the valve

Your surgeon will open up your aorta so that they can see the aortic valve. The damaged valve will be removed, and the new one will be put into place and attached with sutures (a fine thread that is used to join a surgical wound).

The surgeon will start your heart again, using controlled electric shocks, before taking you off the heart-lung machine. Your breastbone will be joined up with wires, and the wound on your chest closed using dissolvable stitches. Tubes will be inserted into small holes in your chest (called chest drains) to drain away any blood and fluid that builds up.

The operation may be performed using smaller incisions and instruments, but you will still need to go on the heart-lung machine. In the future, it may be possible to perform this operation in a less invasive way, without the need for a heart-lung machine.

Valve types

The recent trend seems to be toward using biological valves rather than mechanical ones. However, there are pros and cons associated with using each type of valve.

Mechanical valves

Mechanical valves are made from man-made materials, such as pyrolytic carbon (a material that is similar to graphite), or ceramic, in a ring covered with polyester. They are very hard wearing and long-lasting.

There is a tendency for blood to clot on the surface of the valve. You will have to take anticoagulant (blood thinning) medication for the rest of your life to prevent the clots forming. There is a small risk of blood clots causing a stroke (when the blood supply to your brain is disturbed).

Mechanical valves can make a clicking noise, which can be disturbing at first, although most people soon get used to it.

Biological valves

Biological valves are made from a variety of different animal tissues, including human. 
They can last between 12-15 years.

Anticoagulant medication may be needed for a few weeks after surgery until the valve has settled in. However, with biological valves there is less risk of blood clotting, so anticoagulant medication is not usually needed for the rest of your life, unless you are taking it for other problems.

Biological valves may not last as long in younger, more active people, so a second replacement valve may be necessary.

 

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

Incision
An incision is a cut made in the body with a surgical instrument during an operation.

Bypass
A bypass is when the flow of blood or other fluid is redirected, permanently because of a blockage in the body, or temporarily during an operation.

Aorta
The aorta is a large blood vessel that runs down the abdomen and transports blood away from the heart.

Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

What type of anaesthetic will I have?

An aortic valve replacement is performed under general anaesthetic, which means that you will be in a controlled state of unconsciousness throughout the procedure.

How long will the operation take?

Your surgeon will be able to advise you, but the operation usually takes between 2-3 hours. The time from having the anaesthetic, to waking up in the recovery room, or intensive care unit (ICU), will be around 10-12 hours.

What will my replacement valve be made of?

There are several different types of replacement valves, or prostheses. Your surgeon will be able to advise you about the type of valve that they consider best for you. This will be based on:

  • your age,
  • lifestyle,
  • preferences, and
  • other medical conditions.

Generally, if you are under 60 years of age, the surgeon will probably recommend a mechanical valve replacement. If you are over 65, a biological valve replacement will probably be recommended.

Page last reviewed: 13/07/2011

Following aortic valve replacement, you will be taken to the intensive care unit (ICU) so that the activity of your heart, lungs, and other systems can be closely monitored for the first 24 to 48 hours. You may be kept asleep (anesthetised) for a few hours after your operation, or until the following morning, and you will remain on a ventilator for this time.

Ventilator

A ventilator is an artificial breathing machine that moves oxygen-enriched air in and out of your lungs. This is done through a tube, called an endotracheal tube, or ETT, that is placed in your mouth and sometimes also in your nose. The tube will usually be held in place behind your neck.

When you wake up, the tube will still be in place and may be quite uncomfortable. You will not be able to talk or drink anything. Once the intensive care team are satisfied that you can breathe unaided, you will be taken off the ventilator and the tube will be removed. A mask will be placed over your mouth and nose that will supply oxygen for you to breathe. 

Moving to a ward

Once the doctors who are treating you are satisfied, you will be moved from the ICU on to a surgical ward. This may be a high dependency unit (HDU) for people who need to be kept under observation after an operation. 

You may have several tubes and monitors attached to you. These could include:

  • chest drains - small tubes from your chest to drain away any build up of blood or fluid (these will usually be removed the day after your operation),
  • pacing wires - if necessary, these will be inserted near the chest drains to control your heart rate (they will usually be removed after 4-5 days),
  • wires on sensor pads - these may be placed in various areas and can be used to measure your heart rate, blood pressure and blood flow, and the air flow to your lungs, and
  • a catheter - a tube that is inserted into your bladder so that you can pass urine.

On the ward, your care team will focus on increasing your appetite and getting you back on your feet.

Visiting

While you are in the ICU, your family will be allowed to see you, but you will probably not be able to speak to them because of your breathing tube.

Once you are moved on to a ward, there may be specific times when you are allowed to have visitors. You should be able to find out what these are before you go into hospital. 

Your family can call the hospital for an update on your condition at any time. However, it is better if just one person calls and then passes this information on to other family members, rather than a lot of people calling the hospital.

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

 

Will I be in pain?

As with any major operation, after having an aortic valve replacement you can expect to have some discomfort. However, different people have different pain thresholds.

While you are in hospital, you will be given painkillers to help ease the pain after your anaesthetic wears off. You will also be given advice about painkillers to take at home. You can expect to experience some discomfort around the site of the operation, but this will gradually lessen as the wound heals.

When will I be able to eat?

General anaesthetic can make about one in three people feel sick after their operation, so you may not be able to eat and drink straight away. You will be given a small amount to drink at first, before gradually being given more. Once you are able to eat, you will be given light meals.

When can I get up and walk about?

The nurses, or your physiotherapist (a health professional trained in techniques to improve movement and function), may help you walk around the ward a day or two after your operation. Walking is one of the best forms of exercise because it boosts circulation. Take it slowly to start with and increase gradually. Pace yourself and always stop and rest if you feel tired.

How long will I need to stay in hospital?

You may be admitted on the day of your operation, or the day before. Depending on how well you progress, you should be able to leave the hospital 7-10 days after your operation.

Page last reviewed: 13/07/2011

Research shows that 98 % of people survive their aortic valve replacement operation. Once your wounds have healed, you should be able to go back to your normal activities and you can expect to feel as well, or better, than you did before the operation.

Possible complications

Following an aortic valve replacement there are a number of possible complications, although most of these are rare. Some possibilities are described below.

  • Infection - the new valve can become infected and inflamed (endocarditis), which can damage your heart. You will be given antibiotics to reduce the risk. 
  • Clotting - this is more likely if you have had mechanical valve replacement. You will be prescribed anticoagulant medication if this is a significant risk.
  • The valve may wear out or become damaged - this is more likely if you are less than 60 years of age and have had a biological valve replacement.
  • Irregular heart beat (arrhythmia) - this affects one in four people temporarily and 1-2% need to have a pacemaker fitted (a small battery-operated device that is inserted under the skin in your chest to help your heart beat regularly). 
Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

Page last reviewed: 13/07/2011

Someone from the cardiac rehabilitation team, or physiotherapy department, should visit you before you go home to discuss your rehabilitation with you.

They will be able to give you advice about how to get back to normal, and can tell you if there is a cardiac rehabilitation programme, or support group, that you can join in your area. The aim is to help you recover as quickly as possible and get back to living as full and active a life as you can, while preventing further heart problems.

Recovery time

Following aortic valve replacement surgery, the recovery time will vary from person to person and will depend on:

  • your age, 
  • your overall health and fitness, and 
  • how well you were before the operation.

Your breastbone usually takes about 6-8 weeks to heal, but it may be 2-3 months before you feel completely back to normal.

Going home

You are likely to be pleased and relieved to get home, but you may also feel anxious about your recovery and how you will manage without full-time nursing care. Take things slowly and at your own pace. It is common to experience some or all of the following mild and short-lived symptoms.

  • Loss of appetite - it may take a while for your appetite to return and you may temporarily lose your sense of taste. 
  • Swelling and redness - the site of your incision may be swollen and red, but this will gradually fade over time. Seek medical help if it becomes more, rather than less, painful. 
  • Insomnia 
  • - some people have problems either falling asleep, or sleeping all through the night. This should improve with time. Taking a painkiller before bed may help. 
  • Constipation 
  • - you may find it difficult to empty your bowels. Drinking plenty of fluid (1.2 litres, or 6-8 glasses, a day), and eating plenty of fruit and vegetables, will help. Your doctor may also suggest taking a laxative (a medication to help you pass stools more easily). 
  • Anxiety and depression - this is completely normal after heart surgery. Talk to your friends and family. If you have a cardiac, or district, nurse coming in to visit you, you may want to discuss it with them. You will start to feel emotionally stronger as you regain your health and strength. 

Caring for your wound

You will have a scar where the surgeon cut down your breastbone. The scar will be red at first, but will gradually fade over time.

You should wash your wound using mild soap and water when you have a bath or a shower. In hospital, you should be able to have a shower after your pacing wires have been removed (after four or five days), but you should avoid very hot water and soaking in a bath until your incision wound has healed.

Protect the wound from exposure to sunlight during the first year after surgery because the scar will be darker if it is exposed to the sun.

Call your doctor if you notice:

  • increased tenderness around the incision site, 
  • increased redness or swelling, 
  • pus or oozing, or 
  • a high temperature (fever) of 38C (100.4F) or above.

If dissolvable stitches have been used to close the wound, they should disappear within around three weeks. Other types of stitches may need to be removed by a healthcare professional. You will be given advice about this, and a follow-up appointment to have your stitches removed, if necessary.

Sex

Before your operation, symptoms of fatigue, or shortness of breath, may affect your sex life. You may find that after your operation you feel more like having an active sex life. You can do so as soon as you feel able to, although you should avoid extreme positions and be careful not to put any pressure on your wound until it has fully healed.

Some people find that having a serious illness can cause them to lose interest in sex. In men, the emotional stress can also cause impotence (erectile dysfunction) which is where it is difficult to get and maintain an erection. If you are worried about your sex life, talk to you partner, a support group, or your GP.

Driving

Following your operation, you can be a passenger in a car straight away, but it may be around six weeks after you are discharged from hospital before you are able to drive again. Wait until you feel able to and can comfortably do an emergency stop. If you are unsure, ask your surgeon for advice.

Returning to work

When you can return to work will depend on the type of work that you do, so ask your surgeon for advice. You may be able to return to work 6-8 weeks after you have been discharged from hospital. However, if you do heavy manual work, it may up to three months before you are able to return to work. You may want to think about changing your role to lighter duties, or speaking to your occupational health department, if your workplace has one.

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

When can I…?

These are some approximate guidelines for what you can do when.

When you get out of hospital you can:

  • play cards and board games,
  • do light household chores, such as washing up, or cooking,
  • do some light lifting, but not more than 4.5kg (10 lbs),
  • climb the stairs,
  • have a shower (this is preferred to a bath),
  • eat out, and
  • walk daily for gentle exercise.

After six weeks you can:

  • use a vacuum cleaner,
  • drive a car,
  • do housework,
  • do gardening,
  • have sex, and
  • return to work on light duties.

After two months you can:

  • ride a bike, and
  • go shopping.

After three months you can:

  • swim, and
  • play low-impact sports.

Top tips

  • Take painkillers as advised by the hospital to control any discomfort.
  • Wear loose, comfortable clothing that does not press on your wound.
  • Alternate rest and activity. Be guided by how you feel and take a short rest or nap if you feel like it.
  • Rest for 30 minutes after eating before exercising.
  • Avoid lifting, pushing, or pulling anything heavier than 4.5 kg (10 lbs) for six weeks after surgery, including carrying children, groceries, suitcases, mowing the lawn, vacuuming, and moving furniture.
  • Avoid holding your breath during any activity, particularly when lifting, or opening your bowels.
  • Eat well according to your appetite. Concentrate on a heart-healthy, low-fat diet, and make sure you get your five a day quota of fruit and vegetables.
  • Once you have recovered, make sure that you take regular exercise. Your doctor will be able to advise you about what is suitable.
  • If you smoke, give up, if you have not done so already.

Page last reviewed: 13/07/2011

Alternative treatment options may include those that are described below, but usually valve replacement surgery is the preferred method of treatment.  

Aortic valve balloon valvuloplasty

Aortic valve balloon valvuloplasty involves passing a catheter (a thin plastic tube) through a large blood vessel and in to the heart. A balloon is then inflated to open up the narrowed aortic valve. This can prevent the need for open heart surgery, although, in adults, surgery is still the first treatment choice.

Aortic valve balloon valvuloplasties are no longer used much because the results are usually short-lived. According to the National Institute for Health and Clinical Excellence (NICE) in the UK, the procedure may be recommended if you are too ill, or weak, to withstand conventional valve surgery. In children, it may be used until they are old enough to have valve replacement.

Transcatheter aortic valve implantation

Transcatheter aortic valve implantation is a relatively new procedure that involves accessing the aortic valve through either the femoral artery, or vein (one of your major blood vessels), or through a small surgical incision in your chest.

A balloon catheter (a thin plastic tube with an inflatable balloon on the tip) is guided into your left ventricle (a chamber in your heart), and is used to position the prosthetic valve over the old one.

Transcatheter aortic valve implantation may be used if someone is too frail to cope with the stress of standard valve replacement surgery - for example, due to their age or another illness. There is currently only limited research into this procedure and little is known about the long-term effects. It can lead to a number of serious complications.

Valve repair

Repairing the aortic valve is only possible in some situations, and will depend on the particular defect in your aortic valve. Valve repair may occasionally be an option for aortic regurgitation (leaking), but not for aortic stenosis (narrowing). Possible types of repair include:

  • aortic annuloplasty - using plastic to repair the valve, and
  • supra-coronary graft - grafting (attaching) healthy tissue on to the damaged valve.

Aortic valve
The aortic valve is the valve that controls the flow of blood out of the left ventricle (chamber) of the heart, to the aorta (the body's main artery).

Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.

Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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