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Aortic Valve Repair and Replacement

Aortic Valve Replacement Surgery

Overview

Aortic valve replacement surgery is an open heart surgery to replace the aortic valve. Surgery is performed for stenosis and insufficiency of the aortic valve.

The aortic valve is the heart valve located between the left ventricle (ventricle) and the aorta – the major artery of our body. It opens when the oxygen-rich blood is pumped from the heart to the body, and closes when the blood is pumped from the left atrium to the left ventricle.

If you have aortic valve disease, you might not have any symptoms at the initial stage. However, the disease progresses over time and starts causing the following symptoms.

Symptoms that are probably pointing to an aortic valve disease include chest pain, shortness of breath (dyspnea), fatigue, dizziness, loss of consciousness, and fainting. The disease may progress further, and may cause coronary failure followed by a possible heart attack.

If you are diagnosed with an aortic valve disease, your aortic valve is either repaired or replaced to relieve these symptoms and prevent occurrence of a heart failure.

Why is this procedure done?

If you have aortic valve disease and if your aortic valve damaged so that it cannot be repaired, your coronary surgeon may recommend an aortic valve replacement.

Stenosis, regurgitation or congenital problems of the aortic valve may allow repair of the aortic valve. Repair surgery has some advantages: the risk of infection is low and the need for the blood thinners will be less. So, it may be the first surgical option for aortic valve disease.

When repair of the aortic valve is decided, annuloplasty or valvuloplasty are two possible options. Annuloplasty is based on the principle of strengthening a ring that is found in the structure of the aortic valve. For this purpose, an artificial ring is sutured on the native ring of the aortic valve. In valvuloplasty, problems in the aortic valve are repaired.

Valve repair or replacement will be determined by your cardiovascular surgeon according to the severity of your condition and other criteria and you will be informed about the final decision.

The decision of aortic valve replacement is made according to some criteria. Your doctor will order some tests and examinations to determine whether you meet those criteria or not. At the same time, your age and type and severity of your condition will also be taken into account. If additional heart problems are present, aortic valve replacement can be combined with other cardiac surgeries (coronary artery bypass grafting, surgical treatment of rhythm disorders, etc.).

By asking your cardiovascular surgeon, you can get detailed information about the operation before the surgery.

Risks

The risks that may be faced in an aortic valve surgery are as follows:

  • Bleeding
  • Infection
  • Cardiac rhythm disorders
  • Death
  • Stroke
  • Anesthesia-related complications

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

Our expert surgery team will employ all practices to minimize the risk of complications and our plastic surgeons will preoperatively inform you about risks listed above and all other potential complications and will address all your concerns.

Preparation

The first phase of preoperative preparation is same in all Medicana Hospitals. Once your doctor determined the most appropriate treatment option – repair or replacement - for your condition, your health status is checked to see if you may undergo a surgery. If necessary, you will be started on life style changes and diet to prepare you better for the surgery. At the same time, the concomitant diseases, which will increase the likelihood of complications in the surgery, are also treated.

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

When these preparations are completed and you reach the pre-operative phase, the following procedures are performed.

  • Review of health history
  • A detailed physical examination
  • Evaluation of cardiac functions and structures by ECG and Echocardiography
  • Necessary laboratory tests and radiology studies
  • Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications

You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.

Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.

Surgery and early postoperative period

For the aortic valve replacement surgery, one of the three methods is followed;

1. Open heart surgery: Your surgeon exposes your chest cavity by making a large incision on your breastbone. Your heart is stopped and a device, called heart-lung machine, takes over breathing function of lungs and pumping function of the heart. The aortic valve is repaired or replaced, and the surgery is terminated afterwards by closing the incision.

2. Minimally invasive method: If your condition allows and your surgeon approves, a small incision is made on the chest wall to repair or replace the aortic valve. This method is preferred due to low risk of infection, shorter hospitalization and faster recovery.

3. Percutaneous or transcathater aortic valve replacement: For patients who are not healthy enough to undergo a major surgery, a catheter is placed into one of great arteries. The artificial aortic valve that is advanced through this catheter is used to replace the diseased aortic valve. Or a small incision is made on the rib cage to advance the catheter directly into the heart. Your doctor will decide if you are a good candidate for this procedure or not.

Three types of valves can be used for valve replacement surgeries: biological valve, homograft valve, and mechanical valve. In this regard, you can ask details and superior and inferior features of each type of valves to your surgeon.

Aortic valve replacement surgery is carried out under general analgesia. This implies that you will not feel pain during the surgery. It usually takes about several hours.

If open heart surgery is performed, your breastbone is approximated and closed by wires and the wounds in your chest are closed using absorbable stitches.

You will be transferred to the intensive care unit for regular close monitoring, after the surgery is completed. During your stay in the intensive care unit, all your vital signs (heart rate, blood pressure, breath rate and other vital signs) will be closely monitored. At this stage, you will breathe through a tube that is placed in your throat.

When your follow-up in the intensive care unit is over, you will discharged to the patient room. After a few days of follow-up here, you will be discharged. Before you are discharged, your medications will be planned and prescribed and, suggestions will be made that you need to take into account after the surgery (time to start work, engage in daily life activities and do exercise and sex life etc).

You should see your surgeon for follow-up visits that are scheduled before you are discharged.

If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

Results

Aortic valve repair or replacement is a major surgery. You will need some time to engage in routine daily life activities after the surgery. Your doctor will inform you about when you will be ready to resume your work and social life after the surgery.

However, you should always remember that this will take time and require some precautions.

Long-standing results depend on the use of medications as instructed by your doctor and carefully following the health lifestyle suggestions. Do not smoke or quit smoking, if you are a smoker, and you need to maintain optimal body weight and control your blood pressure, blood glucose and blood lipids well. You may also need to start a cardiac rehabilitation program based on your doctor’s directions. In this program, exercises will be planned that you need to do after a valve replacement or repair surgery.

It is very important in terms of your health that you attend follow-up visits at pre-scheduled dates and you follow the suggestions made at each visit.