What happens before and during an aortic valve replacement?

An aortic valve replacement is a major operation and will only be carried out if you're well enough to have surgery. Preparing for the operation In the weeks before the procedure, you'll attend a pre-admission clinic for an assessment to check whether the operation is suitable. This is also a good time to ask any questions you have about the procedure. As part of this assessment, you may: have a physical examination be asked about your medical history, including any medication you're taking, any Indoor allergy you have and whether you've had a reaction to anaesthesia in the past havetests to check your general and heart health thesemay include a blood test , X-ray , electrocardiogram (ECG) and/or echocardiogram If you smoke, you'll be advised to stop in the lead up to your operation because this can reduce theriskof complications.You should be told when you need to stop eating and drinking before the procedure. When you have the operation, it's likely you'll be in hospital for about a week, so you'll need to make some practical preparations in advance. These include bringing clothes, toiletries and any equipment you use, such as a walking stick or hearing aid.   The operation An aortic valve replacement is carried out under general anaesthetic . This means you'll be asleep during the operation and won't feel any pain while it's carried out. The operation usually lasts a few hours. During the procedure: a large cut (incision) around 25cm long will be made along the middle of your breastbone to allow the surgeon access to your heart, although in some cases a smaller cut may be made tubes are inserted into your heart and major blood vessels, which are attached to a heart-lung (bypass) machine this will take over the job of your heart during the operation medication is used to stop your heart and your main artery (aorta) is clamped shut this allows your surgeon to open your heart and operate on it without blood pumping through the aorta is opened up and the damaged aortic valve is removed the new valve issewn in place with a fine thread your heart is startedagain using controlled electric shocks, before you're takenoff the bypass machine your breastbone is joined upwith wires, and the wound on your chest closed using dissolvable stitches Choice of valve replacement Before having an aortic valve replacement, you'll need to decideon the most suitable type of replacement valve for you. There are two main types of replacement valve: mechanical valves made ofsynthetic materials biological valves made of animal tissue Each type has advantages and disadvantages, which your doctor will discuss with you. Mechanical valves The main advantage of mechanical valves is that they're hard-wearing and less likely to need replacing. This means they're often better for younger people having a valve replacement. However, there's a tendency for potentially dangerous bloodclots to formon the valve, so lifelong treatment with anticoagulant medication such as warfarin is needed to prevent this. This will increase the chances of excessive bleeding from a cut or injury, particularly as you get older, and may not be suitable if you've had significant bleeding problems in the past. Mechanical valves can also make a quiet clicking noise, which can be disturbing at first,but is easy to get used to. Biological valves The main advantage of biological valves is that there's less risk of clots forming, so lifelong anticoagulant treatment isn't usually necessary. However, biological valves tend towear out a bit faster than mechanical valves and may eventually need to be replaced after many years. Therefore, they are often better for older people havinga valve replacement. 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 of the heart to the aorta (the bodys main artery). 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. 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. Incision An incision is a cut made in the body with a surgical instrument during an operation.