Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.

Aortic valve surgery is done to either repair or replace the aortic valve in your heart.

• An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.
• An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.

In open surgery, the surgeon makes a large incision (cut) in your breastbone to reach the heart and aorta.

See also: Aortic valve surgery - minimally invasive

Aortic valve replacement; Aortic valvuloplasty; Aortic valve repair; Replacement - aortic valve; Repair - aortic valve; Ring annuloplasty - aortic valve

Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

• Your surgeon will make a 10-inch-long cut in the middle of your chest.
• Next, your surgeon will separate your breastbone to be able to see your heart and aorta (the main blood vessel leading from your heart to the rest of your body).
• Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

If your surgeon can repair your aortic valve, you may have:

• Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
• Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.

If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.

Once the new or repaired valve is working, your surgeon will

• Close your heart and take you off the heart-lung machine.
• Place catheters (tubes) around your heart to drain fluids that build up.
• Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.

This surgery may take 3 to 6 hours.

Sometimes other procedures are done during open aortic about surgery. These include the Ross (or switch) procedure, the David procedure, and a graft of the ascending aorta.

You may need surgery if your aortic valve does not work properly. You may need open-heart valve surgery for these reasons:

• Changes in your aortic valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.
• Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.
• Your heart valve has been damaged by endocarditis (infection of the heart valve).
• You have received a new heart valve in the past and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Chiam PTL, Ruiz CE. Percutaneous transcatheter aortic valve implantation: Evolution of the technology. American Heart Journal. Feb 2009;157(2).

Otoo CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.