What Is a Surgical Aortic Valve Replacement (SAVR) Procedure?

The traditional way of replacing an aortic valve is with open chest surgery.

The patient is placed under general anaesthesia and the chest opened down the middle of the breast bone (sternum).  This gives excellent access to the heart and the bone heals well afterwards.  There other key-hole surgical approaches that might be suitable in certain circumstances.

The blood leaving the heart is diverted to a heart-lung machine and returned to the body full of oxygen to completely replace the heart function.  The heart is then cooled and stopped to give perfect surgical conditions.  The old valve is removed and a new valve is sewn in place.  Once that is complete the heart is warmed and restarted before returning to normal circulation and closing the chest.

The patient is then taken to the intensive care unit where they usually remain for just one day.  Surgical drains and wires are removed over the next couple of days and the patient would usually leave the hospital at one week. Some patients benefit from a brief stay at inpatient rehabilitation afterwards.

Surgical Aortic Valve Replacement is sometimes combined with other surgery such as Coronary Artery Bypass Graft Surgery (CABGS), or replacement of the beginning of the aorta if needed.

There are two broad types of surgical valves available:

• mechanical
• bioprosthetic

Mechanical valves are made of metal and have the advantage of not wearing out over time.  The disadvantage is that there is a higher risk of blood clotting on the valve.  Patients with a mechanical valve must remain on Warfarin to thin the blood after surgery.

Bioprosthetic valves are made of tissue from cow or pig hearts.  The advantage is that they do not require Warfarin therapy, but the disadvantage is that they wear out over time and may need to be replaced.

An alternative to Surgical Aortic Valve Replacement is Transcatheter Aortic Valve Implantation (TAVI) which exclusively uses bioprosthetic valves.