Bicuspid Aortic Valve Disease Surgery

The normal heart has two upper and two lower chambers. The upper chambers called “right and left atrium” and the lower chambers called “ventricles.” The heart also has four valves (aortic, mitral, tricuspid and pulmonary). These valves keep blood flowing in the right direction, thus, serving as “gates” at the chamber openings.

Normally, the aortic valve has three flaps. However, some people are born with an aortic valve that only has two (bicuspid). Bicuspid aortic valve disease is a type of congenital heart defect (present at birth). A bicuspid aortic valve may cause the heart's aortic valve to narrow (aortic valve stenosis), or leak blood backward (aortic valve regurgitation). Depending on your condition, your doctor will decide at what stage in your life to proceed with surgery. Some people may go their entire life without noticing this.

If surgery is required, it can be used to repair or replace the aortic valve and/or aortic root. This can be accomplished through a variety of methods: Minimally-Invasive (small incisions of 2–3 inches long / general anesthesia), or through open-heart surgery (involves dividing the breast bone / general anesthesia). If your doctor believes you are a candidate, he or she will typically recommend a minimally-invasive approach (transcatheter aortic valve replacement or TAVR). However, the type of method chosen will vary according to your specific medical condition.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Cardiac Catheterization
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress Test

What to Expect During the Procedure

As previously mentioned, the TAVR procedure is most often the preferred method. The procedure usually takes 2 hours, but the preparation and recovery time may add several hours. This procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of the procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Prior to starting the procedure, you will receive a local anesthetic to numb the catheter insertion site(s). Sites may include: Subclavian approach (incision near the shoulder), transapical (incisions in the chest between the ribs), transaortic (incision in the upper chest), or transfemoral (incision in the groin).
• The transfemoral approach is usually the most commonly used.
• Once the local anesthetic has taken effect, a catheter (which includes a compressed heart valve in it) will be inserted and guided directly inside the diseased aortic valve.
• Once in position, the new valve is expanded.
• Once the valve is securely in place, the catheter will be removed from your body and the incision in your leg will be closed with a closure device or sutures.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation. Generally, you’ll spend about 2 to 5 days recovering in the hospital. A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.

General Guidelines

• You must stay in bed as long as recommended by your doctor.
• Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
• Your doctor will give you instructions to follow during your recovery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.