The aortic valve controls blood flow from the heart's primary pumping chamber (the left ventricle) into the main artery of the body (the aorta). When severe valve dysfunction occurs—such as aortic stenosis (narrowing) or aortic regurgitation (leakage)—the heart must work significantly harder to pump blood. The clinical objective of aortic valve repair or replacement is to alleviate strain on the myocardium, relieve symptoms of heart failure, and prevent irreversible cardiac remodeling or premature mortality.

The procedure is performed under general anesthesia. For traditional surgical aortic valve replacement (SAVR), a median sternotomy is performed, and cardiopulmonary bypass (heart-lung machine) is established. The aorta is cross-clamped, and cold cardioplegia solution is delivered to stop the heart safely. The aorta is incised above the valve level to expose the diseased leaflets. In valve repair, the surgeon resuspends, reshapes, or patches the native leaflets. In valve replacement, the calcified native leaflets are excised, the aortic annulus is debrided, and a biological or mechanical prosthetic valve is sutured into place. The aorta is closed, air is evacuated from the cardiac chambers, the aortic cross-clamp is removed, and the heart is restarted. Once off cardiopulmonary bypass, chest drains and temporary pacing wires are placed, and the surgical incision is closed in layers.

Surgical intervention offers substantial clinical benefits, including restoration of normal intra-cardiac hemodynamics, regression of left ventricular hypertrophy, marked reduction in exertional dyspnea and angina, improved functional capacity, and increased long-term survival rates comparable to age-matched controls (ACC/AHA 2020 Guidelines).

Immediate recovery involves 24 to 48 hours of critical care monitoring for hemodynamic stability and cardiac rhythm disturbances. Post-ICU care focuses on mobilization, pulmonary hygiene, and pain control. Full bone healing of the sternum requires 8 to 12 weeks. Long-term recovery includes lifelong cardiology follow-up, periodic echocardiography, and, for patients with mechanical prostheses, continuous oral anticoagulation monitoring.

Aortic valve repair and replacement treat primary cardiac conditions affecting the aortic outflow tract. Key indications include severe symptomatic aortic stenosis, severe aortic regurgitation, congenital valvular anomalies such as bicuspid aortic valve disease, and valvular destruction secondary to infective endocarditis or aortic root aneurysms.

Pre-procedural preparation requires a comprehensive diagnostic evaluation, including transthoracic or transesophageal echocardiography, coronary angiography, computed tomography (CT) of the chest and aorta, carotid artery ultrasound, routine laboratory investigations, and dental clearance to eliminate sources of occult infection. Patients must stop specific antiplatelet or anticoagulant medications prior to surgery as directed by the surgical team. Chlorhexidine skin washes are performed the night before and the morning of surgery to minimize surgical site infection risk.

Potential severe complications include perioperative mortality (1–3% in low-risk elective cases), stroke (1–2%), major bleeding requiring reoperation, postoperative acute kidney injury, surgical site infection, and complete heart block requiring permanent pacemaker implantation (2–5%). Long-term risks associated with prostheses include structural valve degeneration (biological valves) or thromboembolism and bleeding complications related to lifelong anticoagulation (mechanical valves).

The patient journey begins with a comprehensive cardiovascular evaluation, including echocardiography and cardiac catheterization. Once surgery is planned, pre-operative optimization occurs over several weeks. On the day of the procedure, general anesthesia is administered, and the operation is performed via open sternotomy or minimally invasive access. Following surgery, patients spend 1 to 2 days in an intensive care unit before transitioning to a surgical step-down unit. Hospital discharge typically occurs between days 5 and 7, followed by a 6-to-12-week structured cardiac rehabilitation program.