WHAT IS OPEN HEART
AORTIC VALVE SURGERY?
Aortic valve surgery is performed by heart surgeons to treat most commonly, bicuspid valves, other congenital aortic valve diseases, aortic valve stenosis (where the valve that is narrowed and doesn’t open properly. The flaps of a valve may thicken, stiffen or fuse together. As a result, the valve cannot fully open) and aortic valve regurgitation (Aortic regurgitation is leakage of blood through the aortic valve each time the left ventricle relaxes. A leaking (or regurgitant) aortic valve allows blood to flow in two directions. This results in an increase in workload for the heart, thus predisposing it to failure).
AORTIC VALVE SURGERY
There are two types of aortic valve surgery: aortic valve repair and aortic valve replacement.
During aortic valve surgery, including aorta surgery, the aortic valve may be repaired or replaced. The results of your diagnostic tests, the structure of your heart, your age, the presence of other medical conditions and other factors will be considered to determine whether aortic valve repair or replacement is the best treatment approach for you.
Aortic valve surgery can be performed using traditional heart valve surgery or minimally invasive approaches.
TRADITIONAL AORTIC VALVE SURGERY
During traditional aortic valve surgery, a surgeon makes a 6- to 8-inch incision down the center of your sternum, and part or all of the sternum (breastbone) is divided to provide direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.
MINIMALLY INVASIVE AORTIC VALVE SURGERY
Minimally invasive aortic valve surgery is a type of aortic valve repair surgery performed through smaller, 2- to 4-inch incisions without opening your whole chest. This is typically done with a “J” incision and leaves your chest stable. Minimally invasive surgery reduces blood loss, trauma, length of hospital stay and may accelerate recovery.
Most patients who require isolated aortic valve surgery are candidates for minimally invasive aortic valve surgery, but your surgeon will review your diagnostic tests and determine if you are a candidate for this type of surgery.
REPAIR OF AN ENLARGED AORTA
Aortic valve disease is often associated with an enlargement (aneurysm) of the ascending aorta, the initial portion of the aorta (the main blood vessel in the body that originates from the aortic valve).
If the enlargement of the aorta is substantial (usually above 4.5 or 5 cm in diameter), this part of the aorta may need to be replaced. The replacement is done at the time of aortic valve repair or replacement. In patients who have a leaky aortic valve and an enlarged aorta, a special procedure (David procedure) can be performed. The David procedure allows surgeons to repair the aortic valve and simultaneously replace the enlarged ascending aorta.
AORTIC VALVE REPLACEMENT
If valve repair is not an option, your surgeon may replace the valve. The native (original) valve is removed and a new valve is sewn to the annulus of your native valve. The new valve can either be mechanical or biological.
BIOLOGICAL VALVE REPLACEMENT
Biological valves (also called tissue or bioprosthetic valves) are made of tissue, but they may also have some artificial parts to provide additional support and allow the valve to be sewn in place.
Biological valves can be made from porcine tissue, bovine pericardial tissue, or pericardial tissue from other species.
These valves are safe to insert, durable (lasting from 15 to 20 years), and allow patients to avoid lifetime use of anticoagulants (blood thinning medications).
MECHANICAL VALVES REPLACEMENT
Mechanical valves are made completely of mechanical parts, which are non-reactive and tolerated well by the body. The bileaflet valve is used most often.
All patients with mechanical valve prostheses need to take an anticoagulant medication, for the rest of their life to reduce the risk of blood clotting and stroke. This may increase the risk of bleeding. This can be prevented by proper monitoring of a blood parameter called PT/INR.
RISK AND BENEFITS
Aortic valve surgery is usually needed when we have no other option but to address the valve which is diseased and results in cardiac dysfunction and failure.
Surgery should be attempted before the heart decompensates. In these situations, the benefits definitely outweigh the risks. As we lose more time, heart failure and cardiomyopathy set in, which increases the risks associated with surgery.
Past history of heart surgery, your age, co-existing organ disease (such as emphysema, kidney disease, past history of stroke or ischaemic heart disease, etc), or other conditions that require surgical treatment will affect individual risk. Your surgeon will explain the surgical risks