Surgical Aortic Valve Replacement (SAVR): A Patient’s Guide

Introduction to SAVR

Surgical Aortic Valve Replacement (SAVR) is a life-saving procedure for patients with severe aortic valve disease. The aortic valve controls blood flow from the heart to the rest of the body, and when it malfunctions due to stenosis (narrowing) or regurgitation (leakage), SAVR becomes necessary to restore proper circulation.

During SAVR, a surgeon removes the damaged valve and replaces it with a mechanical or biological prosthetic valve. This open-heart surgery has been performed for decades with high success rates, significantly improving patients' quality of life and longevity. While minimally invasive alternatives like TAVR (Transcatheter Aortic Valve Replacement) exist, SAVR remains the gold standard for many patients, especially younger individuals or those with complex anatomy.

Key Points:
  • SAVR treats aortic stenosis and regurgitation.
  • Involves open-heart surgery under general anesthesia.
  • Two valve types: mechanical (long-lasting) and biological (no blood thinners needed).

Why is SAVR Needed? (Indications)

SAVR is typically recommended when the aortic valve is severely damaged, causing symptoms like chest pain, shortness of breath, fatigue, or fainting. These symptoms indicate that the heart is struggling to pump blood efficiently, which can lead to heart failure if untreated.

The most common conditions requiring SAVR are:

Doctors may also recommend SAVR for asymptomatic patients with worsening heart function on imaging tests. Early intervention can prevent irreversible damage to the heart muscle.

Preparing for SAVR Surgery

Preparation for SAVR begins weeks before the operation. Your medical team will conduct tests like echocardiograms, CT scans, blood work, and coronary angiography to assess your heart’s condition and plan the surgery.

Pre-surgery steps include:

On the day of surgery, you’ll be given general anesthesia. The procedure typically takes 3–5 hours, followed by 1–2 days in the ICU and 5–7 days in the hospital. Arrange for a family member or friend to assist you during recovery.

Step-by-Step Procedure of SAVR

SAVR follows a carefully orchestrated process:

  1. Incision: The surgeon makes a 6–8 inch cut down the center of the chest (sternotomy) to access the heart.
  2. Heart-Lung Bypass: A machine temporarily takes over blood circulation and oxygenation.
  3. Valve Removal/Replacement: The diseased valve is removed, and the new valve (mechanical or tissue) is sewn into place.
  4. Closing Up: The heart is restarted, the bypass machine is disconnected, and the chest is closed with wires and sutures.

Some patients may qualify for minimally invasive SAVR, which uses smaller incisions for faster recovery. Your surgeon will decide the best approach based on your anatomy and health.

Risks and Complications of SAVR

While SAVR is generally safe, all surgeries carry risks. Potential complications include:

Choosing an experienced surgical team minimizes these risks. Discuss your concerns with your doctor to understand personalized risk factors.

Recovery and Post-Operative Care

Recovery from SAVR takes time—typically 6–8 weeks for sternal healing and 3–6 months for full energy levels. Here’s what to expect:

Follow-up appointments ensure the new valve is functioning well. Report any fever, chest pain, or unusual swelling immediately.

Life After SAVR: Long-Term Outcomes

Most patients experience dramatic improvements in symptoms and longevity post-SAVR. Studies show:

With proper care, patients return to normal activities, including exercise, travel, and work. Psychological support can help with post-surgery anxiety.

SAVR vs. TAVR: Key Differences

While both replace the aortic valve, SAVR and TAVR differ significantly:

Factor SAVR TAVR
Invasiveness Open-heart surgery Minimally invasive (catheter-based)
Recovery Time 6–8 weeks 1–2 weeks
Best Candidates Younger patients, complex anatomy High-risk or elderly patients

TAVR is newer and less invasive but isn’t suitable for all patients. Your cardiologist will recommend the best option based on age, health, and valve anatomy.