The aortic valve, positioned between the heart’s main pumping chamber, the left ventricle, and the aorta, the body’s largest artery, regulates blood flow to the body. Its function involves opening to allow oxygen-rich blood to flow into the aorta and then closing tightly to prevent blood from flowing backward into the heart. When this valve does not function correctly, it can affect the heart’s ability to circulate blood efficiently, necessitating interventions like Surgical Aortic Valve Replacement (SAVR). SAVR is a common and effective treatment for specific aortic valve problems, involving the replacement of a failing aortic valve with an artificial one.
Understanding the Need for SAVR
The primary conditions necessitating Surgical Aortic Valve Replacement (SAVR) are aortic stenosis and aortic regurgitation. Aortic stenosis occurs when the aortic valve narrows, restricting blood flow from the heart. This forces the heart’s left ventricle to work harder. This increased workload can cause the heart muscle to thicken, enlarge, and weaken, potentially leading to heart failure if left unaddressed.
Conversely, aortic regurgitation, also known as aortic insufficiency, happens when the aortic valve does not close completely. This allows blood to leak backward into the left ventricle, causing the heart to exert more effort to maintain forward blood flow. Both conditions can manifest with symptoms such as shortness of breath, fatigue, chest pain, dizziness, or a fluttering heartbeat. Surgical intervention becomes necessary when symptoms develop or heart function is impacted, to improve blood flow and reduce the risk of complications.
The SAVR Procedure Explained
Surgical Aortic Valve Replacement (SAVR) is an open-heart procedure performed under general anesthesia. The surgeon typically makes a vertical incision, known as a sternotomy, through the breastbone to access the heart. In some instances, a smaller incision may be used in a minimally invasive approach. During the surgery, the patient is connected to a heart-lung bypass machine, which temporarily takes over the functions of the heart and lungs, allowing the surgical team to operate on a still heart.
Once the heart is still, the diseased aortic valve is removed. A new, artificial valve is then sewn into its place. There are two main types of artificial valves used: mechanical valves and bioprosthetic (tissue) valves.
Mechanical valves are constructed from synthetic materials like titanium or pyrolytic carbon, offering long-term durability, often lasting 20-30 years. However, patients with mechanical valves require lifelong blood-thinning medication to prevent blood clots.
Bioprosthetic valves are typically made from animal tissue. These valves are less likely to cause blood clots, often eliminating the need for lifelong anticoagulation. However, bioprosthetic valves are less durable than mechanical valves, generally lasting 10-20 years, which might necessitate another replacement in the future, particularly for younger patients. After the new valve is implanted, the heart is restarted, and the chest incision is closed.
Recovery and Living with a New Valve
Following a Surgical Aortic Valve Replacement (SAVR), patients typically spend about five days in the hospital, including one or two days in the intensive care unit (ICU) for monitoring. During this initial period, care providers manage pain, check for infection at the incision sites, and encourage early mobilization, such as walking and performing breathing exercises. Patients gradually transition from the ICU to a regular ward as they recover.
The full recovery from traditional open-heart SAVR usually takes four to eight weeks, although heavy lifting and strenuous activities may be restricted for up to 12 weeks. Many can resume light desk work within two to four weeks, while jobs requiring physical exertion may need a longer hiatus, potentially six to eight weeks. Patients are encouraged to gradually return to light activities in the first week, with noticeable improvements in energy levels by one month.
Long-term considerations involve regular follow-up medical appointments to monitor the new valve and heart health. For patients with mechanical valves, strict adherence to lifelong blood-thinning medication is essential to prevent blood clots. Cardiac rehabilitation, a supervised program typically lasting 12 weeks, is often recommended to help patients safely return to exercise and adopt heart-healthy lifestyle changes.
Comparing SAVR and TAVR
Surgical Aortic Valve Replacement (SAVR) has been the established treatment for severe aortic stenosis and regurgitation for over 50 years. Transcatheter Aortic Valve Replacement (TAVR) is a newer, less invasive alternative. While SAVR involves open-heart surgery with a chest incision, TAVR utilizes a catheter inserted through a blood vessel, typically in the leg, to deliver and implant the new valve without opening the chest.
The choice between SAVR and TAVR depends on factors, including the patient’s age, overall health, and anatomical considerations. SAVR is generally considered for younger, lower-risk patients who are strong enough to undergo open-heart surgery and its recovery. TAVR was initially approved for patients at high surgical risk but has expanded to include those at intermediate and even some low-risk categories.
Recovery times differ, with TAVR typically leading to shorter hospital stays and a quicker return to daily activities compared to SAVR. However, TAVR valve durability in younger patients is still being evaluated, while SAVR has well-documented long-term outcomes. The decision for either procedure involves a discussion between the patient and their medical team, weighing the benefits and risks to determine the most appropriate treatment.