Aortic Valve Repair Surgery

To evaluate if you’re eligible for aortic valve repair, your surgeon will order certain pre-operative tests, including:

• Cardiac catheterization
• Chest X-ray
• Computed tomography (CT) scan
• Electrocardiogram (EKG)
• Transesophageal echocardiogram (TEE)
• Blood tests and urine tests

If you’re approved for the procedure, your care team will share instructions to prepare for surgery, including:

• When to start fasting prior to your surgery.
• If you should temporarily stop taking any of your medications.
• What time to arrive at the hospital.
• What personal items to bring with you to the hospital and what to leave at home.

Aortic valve repair may be performed as open-heart surgery or minimally invasive surgery. In open-heart surgery, the surgeon accesses the heart and repairs the valve through a large cut (incision) made in the middle of the chest. In minimally invasive surgery, the surgeon uses smaller incisions to access the heart. Your doctor will advise which type of surgery is best for you.

In general, aortic valve repair follows these steps:

1. You will be given medication (anesthesia) to put you in deep sleep-like state. During your surgery, you will not feel any pain or be aware of what’s happening. You will not remember the surgery.
2. To access the heart, the surgeon makes a vertical incision, called a sternotomy, through the breastbone. The incision is generally about 6 inches long. Alternatively, the surgeon may make smaller two- to four-inch incisions without opening the entire chest.
3. The surgeon will connect you to a heart-lung (cardiopulmonary) bypass machine, which allows the heart to be temporarily and safely stopped. The heart-lung machine performs the work of your heart and lungs during the surgery.
4. The surgeon repairs the aortic valve. In doing so, they can employ a number of techniques depending on the unique anatomy and condition of your aortic valve. These techniques include:
   • HAART™ Aortic Valve Repair Technology, which is used to perform annuloplasty, a procedure to reinforce or tighten the valve so that is closes more tightly.
   • Reshaping your valve leaflets
   • Applying tissue patches to tears or holes in the valve.
5. If needed, the surgeon then fixes other issues (such as aneurysms).
6. After all necessary repairs are done, the surgical team closes the incision(s).
7. The care team moves you to recovery.

HAART Aortic Valve Repair Technology

UH Harrington Heart & Vascular Institute is the only approved site in Northeast Ohio and one of three in the state offering the HAART Aortic Valve Repair surgical procedure.

The HAART device is used in annuloplasty, a procedure to reinforce or tighten a faulty heart valve so that is closes more tightly. Composed of Dacron-skirted titanium, the HAART device is an elliptical ring. Its design is based on high-resolution images of healthy aortic valves.

Available for both normal tricuspid (three-leaflet) and bicuspid (two-leaflet) aortic valves, the device is implanted at the base of the valve (the annulus) to stabilize the valve and improve its ability to properly open and close (coaptation).

After aortic valve repair surgery, you will spend a day or more in the intensive care unit (ICU), where you will be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may also be given oxygen.

After leaving the ICU, you will remain in the hospital for several days. During your hospital stay, your care team will:

• Monitor your incision sites for signs of infection.
• Periodically check your blood pressure, heart rate and respiration.
• Work with you to manage any post-surgical pain you may have.
• Encourage you to walk and move around each day.
• Assist you in doing breathing exercises.

Aortic valve repair is a major surgery that carries some risks. You may require another surgery for additional repairs or a valve replacement if:

• The valve continues to leak after your surgery (recurrent aortic regurgitation).
• The valve becomes inflamed due to infection (endocarditis).
• A part of the valve does not function properly following the repair.

Other possible complications of aortic valve repair surgery include:

• Allergic reaction to anesthesia
• Abnormal heart rhythm (arrhythmia)
• Bleeding
• Heart attack
• Heart failure
• Stroke

Age, medical conditions and other factors affect the risk of complications. Your surgeon will discuss your risk factors and what can be done to optimize the success of your surgery.