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Treatment Options

Treatment options for aortic stenosis will depend in part on the severity of your condition. Mild aortic stenosis can be managed with regular observation and medications.¹ If your aortic stenosis becomes more severe, you may need to have your aortic valve replaced.¹

What is SAVR?

Surgical aortic valve replacement (SAVR) is a surgical procedure that requires an incision through the chest and sternum to replace the diseased aortic valve.2

During the procedure, the sternum is opened and spread apart using a surgical instrument. This gives the surgeon access to the heart and chest cavity.2 The surgeon will remove any tissue and calcium deposits that are interfering with the normal function of the heart valve. The diseased valve will also be completely removed. Then, the new valve will be sewn into the space where your old valve used to be.2

There are two types of artificial (prosthetic) replacement valves that can be used:

  • a mechanical valve, made of durable materials
  • a biological tissue valve made from cow, pig or human heart tissue.2
  • After the surgeon makes sure your valve is working properly, blood flow will be restored to your heart and the incision will be closed.
  • The procedure is performed under general anaesthetic and during this time, the function of your heart is taken over by a heart-lung machine called a cardiopulmonary bypass or CPB.2
  • The length of the procedure will vary from person to person, lasting a minimum of 2 hours. 

After the SAVR procedure

Following an SAVR procedure, you will spend some time in the intensive care unit (ICU) where you will be closely monitored to make sure there are no complications.2

In the ICU, staff will keep a close watch on your heart rate, temperature, blood pressure and other vital body signs.

When intensive care monitoring is no longer needed, you’ll be moved to a regular hospital room.2 Typically, you may need to be in hospital for 3 to 10 days.

Recovery can take between 6 and 12 weeks and most patients are able to resume a normal, healthy lifestyle.3

Understanding the benefits and risks of SAVR

BENEFITS OF SAVR

SAVR is an accepted treatment for aortic stenosis, and you can expect to feel some of the benefits of your new prosthetic heart valve almost immediately.

Each patient recovers at his or her own pace. Recovery depends on your overall strength and condition. The effects of your old, damaged valve on your body will gradually fade as your new prosthetic heart valve begins to help your heart function more efficiently. After surgical recovery time you may be able to engage in your normal activities again.

 

RISKS OF SAVR

Please speak to your doctor about any potential risks associated with this procedure that may apply to you. 

 

FREQUENTLY ASKED QUESTIONS ABOUT SAVR

What are the differences between mechanical and biological tissue valves?

A mechanical valve is made of durable materials. A biological tissue valve is made of cow, pig or human heart tissue.2 There are advantages and disadvantages with either choice. 

In general:5

  • A mechanical valve lasts longer than a tissue valve, but you’ll need to take blood-thinning medication for the rest of your life to reduce the risk of blood clots. 
  •  A biological tissue valve does not last as long, but typically does not require life-long blood-thinning medication.

You and your doctor will discuss the risks and benefits of each type of valve to decide which type best suits your needs.

 

Do heart valves make any noise?

All mechanical valves make a little noise. When a mechanical heart valve opens and closes, you may hear two distinct clicking sounds. This is normal.

 

How long will my heart valve last?

The durability of a mechanical or tissue heart valve can be patient dependent. In the literature, mechanical valves in some patients have lasted as long as 25 years without problems.6 Tissue valves in some patients have lasted as long as 15 years without problems.7

 

Will my new valve need special care?

It’s important to ensure any doctor or dentist that you see for any reason is aware that you have had heart valve surgery. You may be required to take antibiotics before any other surgical or dental procedures to reduce your risk of infection.

 

Will a mechanical heart valve set off airport security?

Your Medtronic heart valve products should not activate airport security alarms, depending on the sensitivity of the security system settings9. It is suggested to travel with your device identification card or medical documentation to inform the airport security team that you have a device implanted so they may relieve any concerns you have about airport security procedures and alarms.

 

Can I have an X-ray after a SAVR procedure?

All replacement heart valves are completely safe with x-ray exams.

 

Is it safe to have a magnetic resonance imaging (MRI) scan after an SAVR procedure?

Our heart valves have been tested and found to be compatible during an MRI scan under specific conditions9. Talk with your doctor about this before you undergo an MRI. Ensure the MRI technician is aware that you have a replacement heart valve following an SAVR procedure.  

 

How soon after my SAVR procedure can I expect to see results?

Results vary from person to person. Many people experience relief from symptoms right away. For others, it may take longer to notice a change. Your doctor will help you evaluate the progress of your condition after surgery.

 

How soon after my SAVR procedure can I resume normal activities?

Recovery time depends on many different things, including your overall physical condition before surgery. Typically, recovery takes up to 12 weeks.2,3 Some patients recover faster, others take longer. During this time, you'll gradually regain your energy and should be able to return to your normal routine.

How quickly you recover depends on the kind of surgery you had, your overall strength, and how well your incision heals. A good cardiac rehabilitation program helps you regain your energy and overall good health.

 

If I have a mechanical heart valve implanted, will I need to take medications after my surgery?

With a mechanical valve, your doctor will prescribe blood-thinning (anticoagulant) medication you'll take for the rest of your life. This medication helps prevent the formation of blood clots, which are a serious health risk. 

Because blood-thinning medication helps prevent clots by delaying the blood coagulation process, any cuts or scrapes you get will bleed a little longer than normal. It's important that you follow your doctor's specific instructions and take your medication exactly as instructed.

You may also need to take antibiotics before you have dental work or other surgery. Even a simple procedure like cleaning your teeth can dislodge bacteria that could find their way to your heart valve and cause an infection. Be sure to tell your dentist or doctor you have a mechanical heart valve.

You may need other medications, depending on your overall health and the particular nature of your valve disease.

 

If I have a biological tissue heart valve implanted, will I need to take any medications after my surgery?

Your condition will determine if you have to take blood-thinning (anticoagulant) medication. With biological tissue valves, the need for life-long blood-thinning medication is usually reduced as compared with biological tissue valves the decision and need for any life-long blood thinning medication should be a shared decision with your doctor. Your doctor might put you on blood thinning medication while you're healing. After that, your doctor will look at your risk factors to see if you need to continue on the medication. 

The fact that tissue valves may not require life-long blood-thinning medication makes them ideal for women in their childbearing years, elderly patients, and patients who can't tolerate anticoagulation medication.

You may also need to take antibiotics before you have dental work or other surgery. Even a simple procedure like cleaning your teeth can dislodge bacteria that could find their way to your heart valve and cause an infection. Be sure to tell your dentist or doctor you have a biological tissue heart valve.

 

What are the potential complications of an SAVR procedure?

Discuss your personal situation with your doctor to ensure you understand the risks, benefits, and possible complications associated with SAVR.

 

How can I maintain a healthy lifestyle after my SAVR procedure?

  • Take all your medications as prescribed.
  • Tell your doctor if you have dramatic, unexplained weight gain, fever, pain, or other symptoms.
  • Follow your doctors suggestions on all dietary considerations.
  • Follow your doctor's suggestions about incorporating exercise and other activities into your life.
  • Tell your doctor if you make any lifestyle changes.

 

References: 

1. Mayo Clinic. Aortic stenosis. https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139. [Accessed December 2021]. 2. Mayo Clinic. Heart Valve Surgery. Available at: https://www.mayoclinic.org/tests-procedures/heart-valve-surgery/about/pac-20384901 [Accessed January 2022]. 3. NHS. Aortic Valve Replacement. Available at: https://www.nhs.uk/conditions/aortic-valve-replacement/[Accessed January 2021]. 4. John Hopkins Medicine. Heart Valve Repair or Replacement Surgery. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/heart-valve-repair-or-replacement-surgery [Accessed January 2022] 5. Clinical Research Forum. Risk/benefit comparison of mechanical and biologic valve replacements. Available at: https://www.clinicalresearchforum.org/page/RiskBenefit [Accessed January 2022]. 6. Mosaic Bioprosthesis: Ten year Clinical Update. ©Medtronic, Inc. 2007. 7. David TE, Ivanov J, Armstrong S, Feindel CM, Cohen G. Late results of heart valve replacement with the Hancock II bioprosthesis. J Thorac Cardiovasc Surg. 2001; 121:268-278. 8. Strange G et al. BMC Health Services Research 2021; 21 (790): doi.org/10.1186/s12913-021-06843-0. 9. Living with a new heart valve, NHS https://publicdocuments.sth.nhs.uk/pil2528.pdf