Aortic Valve Surgery: Types and Procedure

What is Aortic valve Surgery?

The aorta is the largest artery in the body that carries blood from the heart to different parts of the body. Several medical conditions can result in poor blood flow through the aorta, resulting in chest pain, breathlessness, fatigue, swelling of the ankles, irregular heartbeats and fainting. 

Aortic valve surgery is done to repair the aorta to re-establish optimal blood flow through it. 

Why Aortic valve surgery is done?

Aortic valve surgery may be performed due to the following medical conditions:

  • Aortic valve diseases, where the valve does not open and close properly resulting in backflow of blood into the heart. This is called aortic stenosis. It can be rheumatic or age-related.

  • Degenerative calcific Aortic stenosis, where the aortic valve becomes narrow due to plaque and calcium deposition resulting in restricted blood flow

  • Congenital defects of the aortic valve

  • Acquired aortic valve disease due to rheumatic fever, infections and valve degeneration, hypertension, tumours, heart attack etc

What are the different types of aortic valve surgery?

The different types of aortic valve surgery include:

  • Aortic valve repair surgery to treat leaky valves

  • Aortic valve hole repair surgery where the hole is sewn with tissue patches

  • Aortic valve replacement which involves the replacement of the damaged aortic valve with a new valve which can be mechanical or tissue valve

What are the most common risk factors of aortic disease? 

The most common risk factors of aortic disease include smoking, positive family history, elderly age and hypertension.

Is aortic valve surgery an open-heart surgery?

Yes, aortic surgeries are open-heart surgery meaning stopping the heart for the time the surgery is being carried out. 

Traditionally, it is done by opening the chest by cutting through the chest bone completely. To reduce these complications, minimally invasive surgeries are preferred in some patients. In the minimally invasive procedure, the sternum is either partially opened up or not opened at all and surgery is carried out through a small incision between the ribs in right 2nd intercoastal space. The key advantages of a minimally invasive procedure include:

  • Smaller incision

  • Faster recovery

  • Lower risk of complications

  • Minimal blood loss and less pain

What is TAVI?

TAVI is transcatheter aortic valve implantation. It is also known as transcatheter aortic valve replacement (TAVR) surgery. It is a minimally invasive procedure just like angioplasty and used to treat aortic stenosis (narrowing of the aortic valve due to plaque and calcium deposition). During the procedure, a new valve is placed over the defective valve to allow optimal blood flow. This procedure is a good option in patients who are at high risk of complications for open-heart surgery, such as patients with pre-existing lung or kidney disease, redo surgery etc.

What are the determining factors for an aortic valve repair or replacement surgery?

The choice of surgery depends upon the severity of the disease, patient age, health status and the presence of other co-morbid conditions.

Not all patients require aortic valve replacement surgery. In general, valve repair is the first choice of treatment as it is associated with a lower risk of infection and reduces the need for blood-thinning medications. However, in many patients, repair may be more complicated than replacement. In such patients, valve replacement is the choice of treatment.

What are replacement valves made of?

Replacement valves may be mechanical or biologic.

The mechanical valves are made up of carbon and polyester and usually last for the lifetime of the patient. However, the patient will need to be put on blood thinners for the rest of their lives.

The biologic valves are made up of human or animal tissues. They do not last as long as mechanical valves, but nowadays the advanced good quality valves are said to have a lifespan of 15-20 years. However, the patient may not be required to take blood-thinners as with mechanical valves. 

What is the success rate of aortic valve surgery?

It depends on the stage of presentation and the presence of associated co-morbid conditions of the patient and the clinical condition of the patient. Generally, there is the risk of 1-2% in otherwise clinically fit patient with no major associated co-morbidities and it is same for midline surgery as well as for minimally invasive surgery. 

How do you prepare for the surgery and what should you expect before surgery?

Before surgery to have your aortic valve repaired or replaced, we will explain to you what to expect before, during and after the surgery and potential risks of the surgery. We will discuss any questions you may have about the procedure.

Before being admitted to the hospital for your surgery, we will tell you about hospital stay and discuss any help you may need when you return home.

For most aortic valve repair and aortic valve replacement procedures, you'll receive anaesthetics so you won't feel any pain, and you'll be unconscious during the surgery.

You'll be connected to a machine which keeps blood moving through the body during the procedure.

You'll generally spend a day or more in the intensive care unit (ICU). The doctor will give you oxygen, fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from the bladder and fluid and blood from the chest.

From the ICU, you'll be moved to a regular hospital room for a few days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure but generally, you will be discharged in 6-7 days.

During the hospital stay, your treatment team will:

  • Watch for signs of infection in your incision sites

  • Periodically check your blood pressure, breathing and heart rate

  • Work with you to manage any pain you have after surgery

  • Encourage you to walk regularly to gradually increase your activity and do breathing exercises as you recover

Recovery time depends on your procedure, overall health before the procedure and any complications.

What is an aortic aneurysm and how can it be repaired through surgery?

An aortic aneurysm is an abnormal bulging or ballooning in the aortic blood vessel. Bursting of an aneurysm can lead to fatal bleeding and may often require surgical correction. Surgical correction may be done through an open incision or in a minimally-invasive procedure known as endovascular aneurysm repair. During the surgery, the weakened portion of the aorta is corrected with the help of a graft. 

 

Dr. Y K Mishra

Chief Of Clinical Services, Head Of Cardiac Sciences And Chief Cardio Vascular Surgeon

Manipal Hospitals, Dwarka, Delhi 

 

 

 

 

 

 

 

 

 

 

 

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