Surgical Procedure Cross-section of the heart, viewed from the front. The aortic valve separates the left ventricle from the aorta. Heart viewed from above, with atria removed to expose the valves. The aortic valve has three sections called leaflets that open to let blood flow.<unk>  is conventionally done through a median sternotomy, meaning the incision is made by cutting through the breastbone (sternum). Once the protective membrane around the heart (pericardium) has been opened, the patient is cannulated (aortic cannulation by a cannula placed on the aorta and a venous canulation by a single atrial venous cannula inserted through the right atrium. The patient is put on a cardiopulmonary bypass machine, also known as the heart–lung machine. This machine breathes for the patient and pumps their blood around their body while the surgeon replaces the heart valve. Once on cardiopulmonary bypass, the patient's heart is stopped (cardioplegia). This can be done with a Y-type cardioplegic infusion catheter placed on the aorta, de-aired and connected to the cardiopulmonary bypass machine. Alternatively, a retrograde cardioplegic cannula can be inserted at the coronary sinus. Some surgeons also opt to place a vent in the left ventricle through the right superior pulmonary vein, because this helps to prevent left ventricular distention before and after cardiac arrest. When the set-up is ready, the aorta is clamped shut with a cross-clamp to stop blood pumping through the heart and cardioplegia is infused. The surgeon incises the aorta a few milometers above the sinotubular junction (just above the coronary ostia, where the coronary arteries join the aorta) – a process known as aortotomy. After this, cardioplegia is delivered directly through the ostia. The heart is now still and the surgeon removes the patient's diseased aortic valve. The cusps of the aortic valve are excised, and calcium is removed (debrided) from the aortic annulus. The surgeon measures the size of the aortic annulus and fits a mechanical or tissue valve of the appropriate size. Usually the valve is fixed in place with sutures, although some sutureless valves are available. If the patient's aortic root is very small, the sutures are placed outside of the aortic root instead of at the annulus, to gain some extra space. Once the valve is in place and the aorta has been closed, patient is placed in a Trendelenburg position and the heart is de-aired and restarted. The patient is taken off the cardiopulmonary bypass machine. Transesophageal echocardiogram (an ultrasound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually controlled should any complications arise after surgery. Drainage tubes are also inserted, to drain fluids from the chest. These are usually removed within 36 hours, while the pacing wires are generally left in place until right before the patient is discharged from the hospital.
Aortic valve replacement
Aortic valve repair
Mitral valve replacement
Mitral valve repair
Heart valve repair
Valve replacement
Percutaneous aortic valve replacement
Mitral valve annuloplasty