Types of Aortic Valve Replacement Procedures

Aortic valve replacement is a type of surgery that replaces a damaged or diseased aortic valve with a mechanical or tissue valve. Aortic valve replacement is the most common surgery for people with aortic stenosis (AS). AS causes the aortic valve to narrow.¹

Valve replacement procedures have become much more advanced in recent years. They are very effective at:²

• Reducing AS symptoms
• Lowering the risk for future health complications, like heart attack and stroke
• Helping people live a long, healthy life

If you need a heart valve replacement, there are several options to consider. It will depend on your condition, how long a replacement valve is expected to last, and any other risks.^1,3

Types of valves

There are 2 types of valves used in valve replacement surgeries:^3-5

• Mechanical valve – This is a long-lasting valve made of metal, plastic, and/or pyrolytic carbon. It typically lasts the rest of a person’s life. However, there are limitations. You will need to take blood thinner medicine for the rest of your life to prevent valve malfunction and blood clots.
• Tissue valve – This valve is made of human or animal donor tissue, also called bioprosthesis. It lasts about 10 to 20 years. A 2023 study found that aortic valve replacements done with bioprosthesis tissue have better overall outcomes than mechanical valves, and they do not require taking blood thinners.

Types of surgeries

People with AS can choose from several types of surgical procedures. These are the most common:^1,2

• Surgical aortic valve replacement (SAVR)
• Transcatheter aortic valve replacement (TAVR)
• Ross procedure

Surgical aortic valve replacement

SAVR is the traditional method and involves open-heart surgery. During the surgery, the surgeon makes an incision in the chest, removes the damaged valve, and replaces it with a mechanical or tissue valve.^2,6

SAVR has been safely performed for more than 50 years. It is a very common surgery, performed on tens of thousands of people each year.⁶

SAVR requires general anesthesia, which puts you to sleep. You are then connected to a heart-lung machine, which allows the surgical team to safely perform surgery on your heart. People who get SAVR can expect to stay in the hospital for about a week.⁶

Full recovery can take 6 to 8 weeks. After you have fully recovered, your doctor will likely recommend that you follow a cardiac rehab program. This supervised program provides:⁶

• Physical therapy
• Counseling
• Nutrition support
• Regular follow-up visits with your doctor

Transcatheter aortic valve replacement

TAVR is a minimally invasive procedure that does not require open-heart surgery. This means it requires less recovery time than SAVR. Therefore, it has become the preferred method of aortic valve replacement. TAVR is also known as ​​transcatheter aortic valve implantation (TAVI).^1,2,7,8

During TAVR, a surgeon inserts a new valve through a catheter in the femoral artery (in the groin) or a small incision in the chest. With TAVR, the damaged valve is not removed. Rather, the replacement valve is inserted within the existing valve and expanded into place.^7,8

TAVR is performed under local anesthesia with sedation or general anesthesia. The whole procedure typically takes about 1 to 2 hours. You can expect to go home from the hospital within 1 to 3 days.^7,8

Recovery time for TAVR is much shorter than SAVR, making this an ideal option for many people. With fewer and smaller incisions, healing time is much faster.^7,8

Those who undergo TAVR should avoid physical activity and should not do any heavy lifting for about 1 week. Most people return to work after about 2 weeks. You can expect a full recovery at about 12 weeks. Follow-up includes regular doctor visits to monitor the new valve's function and a cardiac rehab program.^7,8

Ross procedure

During this procedure, the surgeon takes your healthy pulmonary valve and moves it into the position of the damaged aortic valve. Then, they replace the pulmonary valve with a donor valve.⁹

The Ross procedure is recommended for those under the age of 60 and who have one of the following:⁹

• Congenital aortic stenosis
• Aortic valve endocarditis
• Another type of aortic valve disease

During a Ross procedure, you will be given general anesthesia. You will then be hooked up to a heart-lung machine. After the surgery, you will stay in the intensive care unit (ICU) for close monitoring. The total hospital stay typically lasts about 1 week.⁹

The recovery period involves regular follow-up visits, a cardiac rehab program, and a gradual return to normal activities over several months. With the Ross procedure, you will likely need another valve replacement surgery within 15 to 20 years.⁹

What are the risks of aortic valve replacement?

Like any surgery, aortic valve replacement carries risks. These risks can include:^2,6,8

• Complications such as bleeding, infection, blood clots, stroke, and heart attack
• Valve malfunction or failure, which might require further surgery
• Irregular heartbeats (arrhythmias) or heart block requiring a pacemaker
• Atrial fibrillation (Afib)
• Complications from anesthesia

These risks are relatively rare. They vary depending on the type of valve used (mechanical or tissue) and the chosen procedure (SAVR, TAVR, or Ross). Older adults and those with other health problems may face higher risks.^2,6

Which procedure is right for you?

The type of procedure you get will depend on many things, like:^1,2

• Your age
• Your overall health and any other health conditions you may have
• How severe your symptoms are
• Your surgical risk
• Whether you are willing and able to take blood thinners for the rest of your life (for mechanical valves)

Considering whether to have an aortic valve replacement is a big decision. Some people may not be candidates for a specific procedure, based on a variety of factors like those listed above. Talk with your surgeon and healthcare team to determine a treatment plan that is right for you. They will discuss the benefits and risks of each surgery with you.²