Aortic valve replacement
Open-heart surgery to replace a worn or narrowed aortic valve with a mechanical or tissue valve, so blood can flow freely out of the heart again.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It replaces a narrowed or leaky aortic valve so blood can flow out of the heart properly, easing breathlessness and chest symptoms.
- The key choice is mechanical (very durable but needs lifelong blood thinners) versus tissue (usually no lifelong blood thinners but may wear out and need replacing).
- This is open-heart surgery: most people stay about a week and take 2–3 months to recover fully.
- For some higher-risk or older people, a catheter-based valve (TAVI) may be an option, so ask how the heart team chose surgery for you.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Relieves the strain a narrowed or leaky valve puts on the heart
Your valve disease is mild or not yet causing symptoms, so monitoring may be safer than surgery now.
You are cared for in intensive care or a high-dependency unit, with close monitoring, drains and lines that are removed as you stabilise.
A named contact and clear out-of-hours route for chest, breathing, rhythm or wound problems.
You are cared for in intensive care or a high-dependency unit, with close monitoring, drains and lines that are...
You move to a ward, start getting up and walking, and do gentle breathing exercises. Most people go home around a...
Tiredness is normal and the chest feels tight. Avoid heavy lifting, pushing and pulling to protect the breastbone...
Energy returns and many people resume light work and most activities. Cardiac rehabilitation helps rebuild fitness...
What is an aortic valve replacement?
The aortic valve is the one-way door between the heart's main pumping chamber and the body's main artery (the aorta). Over time it can become narrowed (aortic stenosis) or leaky (aortic regurgitation), so the heart has to work harder. A replacement removes the faulty valve and sews in a new one.
This is open-heart surgery: the surgeon usually opens the breastbone and uses a heart-lung machine to take over while the heart is stopped and the new valve is fitted. Some people are suitable for a smaller-incision (minimally invasive) approach.
The big decision is which type of valve. A mechanical valve is very hard-wearing but needs lifelong blood-thinning medicine. A tissue (animal-tissue) valve usually does not need lifelong blood thinners but tends to wear out over time and may need replacing later. Your age, other conditions and preferences all matter.
For some people, especially older or higher-risk patients, a less invasive catheter-based option called TAVI may be considered instead. A heart team should help you weigh these up.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Mechanical vs tissue aortic valve
| Point | Mechanical valve | Tissue valve |
|---|---|---|
| Durability | Very long-lasting, rarely wears out | Usually about 15–20 years |
| Blood thinners | Lifelong (usually warfarin) with blood tests | Often not needed long term |
| Bleeding risk | Higher, from lifelong blood thinning | Lower |
| Often suits | Younger patients | Older patients, or those who can't take blood thinners |
Neither valve is 'best' for everyone. The choice balances how long the valve lasts against the burden and bleeding risk of lifelong blood thinners, plus your age and lifestyle.
Preparing for your surgery
- Meet the operating surgeon and anaesthetist, who explain the operation, your personal risks and the valve choices.
- Expect tests such as an echocardiogram, ECG, blood tests, and often a coronary angiogram to check the heart arteries.
- Discuss mechanical versus tissue valve carefully, including how lifelong blood thinners would fit your life.
- Tell the team about all medicines and supplements; blood thinners and some other medicines need adjusting beforehand.
- Have a dental check, as treating dental infection first lowers the risk of a dangerous valve infection (endocarditis).
- Stop smoking as far ahead as possible to reduce wound, lung and healing problems.
- Arrange help at home and someone to drive you, as you will not be able to drive for several weeks.
What happens
The operation is done under general anaesthetic. In standard surgery the surgeon makes a cut down the centre of the chest and divides the breastbone to reach the heart.
A heart-lung machine takes over the work of the heart and lungs, the heart is stopped, and the surgeon removes the damaged valve and stitches the new one into place. The breastbone is then closed with permanent wires and the skin closed with dissolving stitches or clips.
The operation usually takes a few hours. You wake up in intensive care or a high-dependency unit, often with a breathing tube for a short while, drains and monitoring lines, which are removed over the following days as you recover.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your valve disease is mild or not yet causing symptoms, so monitoring may be safer than surgery now.
- You are too frail or unwell for open-heart surgery, where TAVI or medical management may be considered instead.
- A mechanical valve is being considered but you cannot safely take lifelong blood thinners.
- Severe other illness means the risks of surgery outweigh the likely benefit.
Delay surgery if…
- You have an active infection, including dental infection, that should be treated first.
- Symptoms are mild and there is time to confirm severity and the best valve choice.
- Important results are missing, such as up-to-date echocardiogram or angiogram findings.
- Blood thinners or other medicines need safe adjustment before surgery.
- You need time to stop smoking or optimise other conditions.
Alternatives to discuss
- TAVI (catheter-based valve) for selected, often higher-risk or older patients.
- Careful monitoring with echocardiograms if the valve disease is not yet severe or causing symptoms.
- Medicines to manage symptoms and other heart conditions, though these do not fix the valve.
- Aortic valve repair in selected cases of a leaky valve, where suitable.
- A second opinion or formal heart-team review if the best option is unclear.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Relieves the strain a narrowed or leaky valve puts on the heart
- Often improves breathlessness, chest tightness, dizziness and tiredness
- Can improve survival when severe aortic valve disease is causing symptoms
- The new valve works immediately, restoring normal one-way blood flow
- A mechanical valve, in particular, is very unlikely to wear out
Risks & complications
- Tiredness, low mood and poor appetite for several weeks
- Chest-wound pain and tightness as the breastbone heals
- An irregular heartbeat (often atrial fibrillation) in the first days
- Temporary problems with memory and concentration
- Wound or chest infection, sometimes affecting the breastbone
- Bleeding needing a return to theatre or a blood transfusion
- A heart-rhythm problem needing a permanent pacemaker
- A temporary effect on kidney function
- Bleeding problems if you need lifelong blood thinners
- Stroke during or soon after the operation
- Infection of the new valve (endocarditis), which is serious
- Death — uncommon for planned isolated valve replacement, but a real risk that rises with age and other illness
The main risks to weigh are stroke, bleeding, rhythm problems needing a pacemaker, valve infection and, rarely, death, and these rise with age, frailty and other heart, lung or kidney disease. If you may receive a mechanical valve, ask how lifelong blood thinning would fit your life. Ask the surgeon for your own estimated risk and why surgery rather than TAVI is being recommended.
Published figures to discuss
Risk after aortic valve replacement varies with age, frailty, heart and kidney function and other illness, so a single number can mislead. UK outcomes are audited nationally and published by hospital and surgeon. The figures below reflect reported ranges for planned isolated surgical aortic valve replacement; your personal risk should be estimated for you. Combined operations, such as adding a bypass, carry higher risk.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Death (in-hospital / 30 days) after planned isolated surgical AVR | Around 1–2% in recent UK data for isolated AVR | A UK study of nearly 80,000 isolated AVRs reported in-hospital/30-day mortality falling to about 1% by 2018; combined operations carry higher risk. | Trend and early outcomes in isolated surgical AVR in the UK — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Stroke around the time of surgery | Roughly 1% or so for isolated surgical AVR in UK data | Reported stroke (CVA) rates in a large UK series were around 0.5%; individual risk rises with age and arterial disease. | Trend and early outcomes in isolated surgical AVR in the UK — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Need for a permanent pacemaker | Usually around 3–5% after surgical AVR in published series, lower than after TAVI | Risk is higher with pre-existing conduction disease, older age and some valve/anatomy factors; ask for the unit's current figure. | Trend and early outcomes in isolated surgical AVR in the UK — PMCpmc.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is gradual because the breastbone has to heal like any broken bone. Most people take 2–3 months to feel fully recovered after open surgery; minimally invasive surgery can be quicker.
- Feeling drained or emotional for the first few weeks
- A tight, sore or numb feeling along the chest wound
- Disturbed sleep and a reduced appetite early on
- Clicking or aching in the breastbone that eases as it heals
- Hearing a faint clicking from a mechanical valve, which is normal
Aftercare
- Take all medicines as prescribed; if you have a mechanical valve, never miss your blood thinner and attend monitoring.
- Keep wounds clean and dry and watch for signs of infection.
- Build up walking gradually rather than resting completely.
- Avoid heavy lifting, pushing and pulling for about 3 months while the breastbone heals.
- Do not drive until your team and the driving-licence rules allow (usually at least 4 weeks). These rules are set by the DVLA in England, Scotland and Wales, and by the DVA in Northern Ireland, so check with whichever applies to you.
- Tell any dentist or doctor you have a replacement valve, as you may need antibiotics for some procedures.
- Attend cardiac rehabilitation and keep follow-up appointments.
- Someone to drive you home and help for the first days
- A supply of your medicines and, if relevant, your blood-thinner monitoring plan
- Loose, comfortable clothing that does not press on the chest wound
- A cushion to hold against your chest when coughing
- Help arranged with shopping, cooking and chores for several weeks
- An alert card or note that you have a replacement heart valve
- Clinic and out-of-hours contact numbers saved
Scars and how they heal
You will have a scar down the centre of the chest where the breastbone was opened, or smaller scars if minimally invasive surgery was used. Scars are firm and pink at first and usually fade over many months. Protecting them from strong sun while healing helps them settle.
⚠ Get urgent help if…
- Signs of stroke — face drooping, arm weakness or slurred speech — call 999 immediately
- Sudden or worsening breathlessness, or fainting
- Chest pain that does not settle
- A wound that is increasingly red, hot, swollen or leaking, or a clicking, unstable breastbone
- Fever or feeling generally unwell, which can signal a valve or wound infection
- Unusual bruising, or bleeding that won't stop, if you take blood thinners
- A fast or very irregular heartbeat with dizziness
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A successful aortic valve replacement relieves the strain on the heart and usually improves symptoms such as breathlessness, chest tightness and dizziness as you recover. When severe valve disease was causing symptoms, surgery can also improve how long and how well you live.
The operation does not make the heart young again, and some changes from years of valve strain may not fully reverse. A tissue valve will tend to wear over time, and any replacement valve carries a small ongoing risk of infection, so lifelong follow-up and dental care matter.
A mechanical valve is very unlikely to wear out and can last for decades, but the trade-off is lifelong blood thinning. A tissue valve usually lasts around 15–20 years, and sometimes less in younger people, before it may need replacing — increasingly this can be done with a catheter (valve-in-valve) rather than repeat open surgery. Your surgeon will explain what is realistic for your age and valve choice.
Combining with other procedures
Aortic valve replacement is sometimes done in the same operation as a coronary artery bypass, or surgery on another valve, if more than one problem is found. Combining procedures increases the size and risk of the operation, so the heart team will discuss whether doing everything at once is right for you.
Follow-up & long-term care
You will usually be reviewed in the weeks after surgery to check your wounds, rhythm and recovery, with cardiac rehabilitation alongside. Longer term you will have periodic checks, often including echocardiograms to watch the valve, and if you have a mechanical valve, regular blood-thinner monitoring for life.
- Lifelong blood-thinning medicine and regular blood tests if you have a mechanical valve
- Good dental care and telling clinicians you have a replacement valve, to reduce infection risk
- Periodic echocardiograms to check the valve, especially a tissue valve over time
- Managing blood pressure and other heart risk factors
- Prompt review if breathlessness, dizziness or fainting returns
Revision and secondary surgery reality
- A tissue valve tends to wear over time (often around 15–20 years) and may need replacing.
- A worn tissue valve can sometimes be treated with a catheter valve-in-valve rather than repeat open surgery.
- Repeat (redo) open-heart surgery is technically harder and carries higher risk than the first operation.
- A mechanical valve rarely wears out, but the trade-off is lifelong blood thinning.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A named contact and clear out-of-hours route for chest, breathing, rhythm or wound problems.
- A structured cardiac rehabilitation programme.
- Clear medicine instructions and, for mechanical valves, a reliable blood-thinner monitoring plan.
- Advice on dental care and antibiotic cover to reduce valve-infection risk.
- Planned echocardiogram follow-up to watch the valve over time.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon's and anaesthetist's fees
- Operating theatre, perfusion (heart-lung machine) and intensive-care time
- The type of valve used (mechanical or tissue)
- Whether surgery is open or minimally invasive, and whether other procedures are combined
- Length of hospital and intensive-care stay, longer if complications occur
- Pre-operative tests and, for mechanical valves, ongoing blood-thinner monitoring
- Cardiac rehabilitation and follow-up echocardiograms
- The surgeon's and anaesthetist's fees
- Theatre, perfusion and intensive-care charges
- The valve (device) cost and which type is included
- Pre-operative tests and assessments
- Expected hospital length of stay and the cost of extra days
- Follow-up appointments, echocardiograms and, if relevant, blood-thinner monitoring
- What happens, and who pays, if there is a complication, longer stay or readmission
On the NHS? Aortic valve replacement is commonly provided by the NHS when clinically indicated; private care is mainly used for choice of surgeon, hospital or timing rather than a different operation.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Valve choice (mechanical vs tissue) decided without a full discussion of the trade-offs for your life.
- No clear explanation of why surgery is preferred over TAVI for you.
- Risks of stroke, pacemaker, bleeding and death not given as your personal estimate.
- Lifelong blood thinning and its monitoring not explained before agreeing to a mechanical valve.
- No written aftercare, dental-care and warning-signs plan before discharge.
Marketing red flags
- Describing open-heart valve surgery as 'routine' or 'low risk' without your own figures.
- Steering you toward one valve type without explaining the trade-offs.
- Promising a 'permanent' fix without mentioning tissue-valve wear or infection risk.
- Downplaying recovery time, breastbone healing or the value of cardiac rehabilitation.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Do you recommend a mechanical or tissue valve for me, and why?
- Would TAVI be a reasonable alternative in my case?
- What is my personal estimated risk of stroke, pacemaker, bleeding and death?
- If I have a mechanical valve, how will lifelong blood thinning be monitored?
- Could I have minimally invasive surgery, and would it suit me?
- What follow-up and valve checks will I need over the years?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Mechanical or tissue valve — which should I choose?
Could I have TAVI instead of open surgery?
Will I have to take warfarin for life?
How long is the recovery?
Is this available on the NHS?
Can I hear a mechanical valve?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — How a heart valve replacement is done NHS — Complications of a heart valve replacement British Heart Foundation — Heart valve replacement surgery NICE NG208 — Heart valve disease in adults Trend and early outcomes in isolated surgical AVR in the UK — PMC Pacemaker implantation after surgical aortic valve replacement — JAMA Network Open DVLA — Assessing fitness to drive DVA Northern Ireland — Telling DVA about a medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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