Introduction

Aortic valve surgery is a major medical procedure designed to repair or replace a damaged aortic valve, the vital structure that controls blood flow from the heart into the aorta and onward to the rest of the body. This valve ensures that oxygen-rich blood moves in one direction out of the heart. When the aortic valve becomes narrowed (aortic stenosis) or leaky (aortic regurgitation), it disrupts this flow, forcing the heart to work harder and eventually leading to heart failure if left untreated.

Aortic valve surgery offers a life-saving solution for many individuals suffering from valve disease. With modern advancements in surgical techniques, such as minimally invasive procedures and catheter based replacements, the surgery has become safer and more effective. However, regardless of the specific method used, the process of aortic valve surgery follows a structured medical pathway from diagnosis to recovery that ensures patient safety and optimal outcomes, highlighting the critical importance of understanding the process of aortic valve surgery.

Process of Aortic Valve Surgery

Diagnosis and Evaluation :- The journey begins with a clinical evaluation when a patient presents symptoms such as chest pain, fatigue, shortness of breath, or fainting spells. A physician may detect abnormal heart sounds through a stethoscope, leading to further diagnostic testing. Echocardiography (heart ultrasound) is the most commonly used imaging technique to assess valve structure and function. Additional tests may include electrocardiograms, chest X-rays, CT scans, cardiac MRIs, or cardiac catheterization. The purpose of these investigations is to determine the severity of the valve disease, assess heart function, and rule out other conditions. Once aortic valve disease is confirmed and deemed severe enough to warrant surgical intervention, a multidisciplinary heart team evaluates the patient’s overall health to determine the most suitable surgical approach.
Preoperative Preparation :- Once surgery is scheduled, patients undergo a series of preoperative preparations. These include routine blood work, urine tests, and assessments for anesthesia fitness. A conversation with the anesthesiologist helps evaluate any allergies, breathing issues, or medication concerns. Patients are also counseled about the procedure, risks, and recovery expectations. Instructions are given to avoid food and drink several hours before the operation. In some cases, patients may need to stop certain medications such as blood thinners a few days before surgery. The surgical team ensures that the patient is in optimal condition, both physically and mentally, before proceeding.
Anesthesia and Surgical Access :- On the day of surgery, the patient is brought into the operating room and administered general anesthesia, rendering them unconscious and pain-free during the procedure. A breathing tube is inserted and connected to a ventilator to support respiration. For open-heart surgery, a midline incision is made through the sternum (breastbone) to expose the heart. In minimally invasive surgeries, smaller incisions are made either in the upper chest or between the ribs. Once the heart is accessed, the patient is placed on a heart-lung bypass machine that temporarily takes over the heart’s pumping and oxygenation functions.
Removal of the Diseased Valve :- With the heart temporarily stopped and the blood circulation maintained artificially, the surgeon identifies the diseased aortic valve. Whether the valve is narrowed due to calcification or is leaking due to poor closure, the entire structure is carefully removed. In cases of valve repair rather than replacement, only the damaged parts of the valve are adjusted or reconstructed. Removing the faulty valve prepares the site for the placement of a new valve, which restores proper one-way blood flow from the heart to the rest of the body.
Valve Replacement :- The surgeon then proceeds to implant the new valve. There are two main types of replacement valves: mechanical valves and biological (tissue) valves. Mechanical valves are made from durable materials like titanium or carbon and last a lifetime, but they require the patient to take lifelong blood-thinning medication. Biological valves, made from animal tissue (usually pig or cow), are more natural and generally do not require long-term anticoagulation but may wear out over time and need to be replaced. The chosen valve is sewn into place with extreme precision to ensure a secure and leak-free fit. In transcatheter procedures such as TAVR, the new valve is delivered through a catheter and expanded into place using a balloon or self-expanding mechanism.
Closing the Chest :- Once the new valve is secured and functioning correctly, the heart is restarted, and the heart-lung bypass machine is gradually weaned off. The surgeon checks for any bleeding or abnormalities before proceeding to close the surgical site. In open procedures, the sternum is wired together to promote bone healing, and the chest incision is closed with sutures or staples. In minimally invasive approaches, small incisions are closed with absorbable sutures or surgical glue. Drainage tubes may be placed temporarily to remove any excess fluid or blood from around the heart.
Postoperative Recovery in ICU :- After surgery, the patient is transferred to the intensive care unit (ICU) for close monitoring. Vital signs, heart rhythms, oxygen levels, and neurological status are observed continuously. Pain management and fluid balance are carefully controlled. Most patients remain in the ICU for 24 to 48 hours, after which they are shifted to a regular hospital room. Breathing tubes, catheters, and IV lines are gradually removed as the patient stabilizes. Physical therapy is initiated early, with patients encouraged to sit up, stand, and walk as soon as possible to prevent complications like blood clots and pneumonia.
Hospital Stay and Discharge :- The average hospital stay after aortic valve surgery ranges from 5 to 10 days, depending on the complexity of the procedure and the patient’s recovery rate. Patients are provided with discharge instructions that include medications, wound care, physical activity guidelines, and dietary recommendations. They are advised to avoid heavy lifting, strenuous exercise, or driving for several weeks. Medications may include pain relievers, blood thinners, antibiotics, or drugs to regulate heart rhythm and blood pressure. A follow-up appointment is scheduled within a week or two to assess healing and monitor heart function.
Cardiac Rehabilitation :- Full recovery from aortic valve surgery may take 6 to 12 weeks, during which the body heals from surgical trauma and adapts to the new valve. Patients are encouraged to enroll in a cardiac rehabilitation program that provides supervised exercise, lifestyle education, and emotional support. Regular follow-up visits with a cardiologist are necessary to monitor the new valve’s performance, manage medications, and detect any potential complications early. Most patients experience significant improvement in symptoms, exercise tolerance, and overall quality of life following a successful aortic valve operation.

Conclusion

The process of aortic valve surgery involves a series of carefully coordinated steps that span from initial diagnosis to complete recovery. Each phase clinical evaluation, surgical preparation, valve replacement, and rehabilitation—plays a critical role in ensuring a successful outcome. With advancements in technology and refined surgical techniques, aortic valve surgery has become safer, more effective, and more accessible than ever before.

Whether performed through open-heart surgery, minimally invasive methods, or catheter-based procedures like TAVR, the ultimate goal remains the same: to restore normal heart function, improve blood flow, and enhance the patient’s quality of life. Patients facing this surgery should be well-informed, actively engaged in their care, and supported by a multidisciplinary heart team that tailors treatment to their unique health needs.

Timely intervention and adherence to postoperative care significantly influence the long-term success of aortic valve surgery. With the right approach, most individuals can expect to return to their daily lives with renewed energy and a healthier heart.