Aortic Valve Repair and Replacement
Overview
Aortic valve replacement is a procedure involving open heart surgery to substitute the aortic valve. This operation is necessitated by conditions such as stenosis and malfunction of the aortic valve.
Positioned between the left ventricle and the aorta, the main artery in our body, the aortic valve plays a crucial role. It facilitates the flow of oxygen-rich blood from the heart to the rest of the body by opening during the heart's pumping phase and closing as blood moves from the left atrium to the left ventricle.
Early stages of aortic valve disease often present without symptoms. As the condition advances, however, it begins to manifest through various signs.
Typical symptoms indicative of aortic valve disease range from chest discomfort and breathlessness to extreme fatigue, vertigo, episodes of unconsciousness, and even fainting spells. Advanced stages of the disease can lead to heart failure and raise the risk of heart attacks.
Upon diagnosis with aortic valve disease, treatment involves either repairing or replacing the damaged valve. This intervention aims to alleviate symptoms and avert the risk of heart failure.
Why is this procedure done?
In cases where aortic valve disease has led to significant damage, making repair unfeasible, your heart surgeon may advise proceeding with an aortic valve replacement.
Conditions such as stenosis, regurgitation, or birth-related issues of the aortic valve might still permit repair efforts. Opting for valve repair can offer benefits like a reduced risk of infection and a lesser dependency on blood-thinning medications, making it a preferable initial approach for addressing aortic valve disease.
Repair techniques, such as annuloplasty or valvuloplasty, are considered based on the specific issue. Annuloplasty involves reinforcing the valve's existing ring structure with an artificial ring, while valvuloplasty focuses on correcting the valve's flaws directly.
The choice between repair and replacement hinges on the disease's severity and other factors, with your cardiac surgeon guiding you through the decision-making process.
Criteria are in place to guide the decision towards valve replacement, including thorough testing and evaluation by your healthcare provider. Factors like age, the specific nature, and severity of your condition, along with the presence of other cardiac issues, are taken into account. Should there be additional heart concerns, aortic valve replacement might be conducted alongside other heart surgeries, such as coronary artery bypass grafting or procedures to address rhythm disorders.
Prior to your surgery, it's essential to discuss the procedure in depth with your heart surgeon to understand all aspects of the operation.
Risks
Risks Associated with Aortic Valve Surgery:
• Bleeding
• Infection
• Disorders related to heart rhythm
• Potential for mortality
• Stroke
• Complications due to anesthesia
Despite the comprehensive precautions taken in line with advanced medical practices to mitigate these risks, it's important to recognize that it's not possible to guarantee their complete elimination.
Our highly skilled surgical team is committed to reducing the likelihood of these complications. Additionally, our team of experts will provide a thorough pre-surgery briefing on the mentioned risks and any other possible complications, ensuring you are fully informed and your concerns are addressed.
Preparation
The initial step in the pre-surgery planning at all Medicana Hospitals begins uniformly. Following your physician's determination of the most fitting approach—either repair or replacement—for your ailment, a comprehensive assessment of your health is conducted to ensure your eligibility for surgery. Should it be deemed necessary, you may be advised to implement lifestyle modifications and dietary adjustments to better prepare you for the upcoming procedure. Concurrently, any existing conditions that could heighten the risk of surgical complications are addressed and managed.
Once cleared for surgery, indicating no significant risks are associated, individuals who smoke will be encouraged to cease smoking, and the use of certain medications known to elevate bleeding risks may be suspended. The intake of all other medications, including over-the-counter drugs, herbal remedies, and supplements, will be thoroughly reviewed. Based on this review, you will receive guidance on which substances to continue or discontinue.
Upon completing these preparatory steps and moving into the preoperative stage, specific protocols are set into motion.
• A thorough examination of your medical history
• An in-depth physical examination
• Analysis of heart function and structure using ECG and Echocardiography
• Conducting essential lab tests and radiological evaluations to lessen the risk of anesthesia-related issues, with assessments by anesthesiologists and other pertinent lab and radiology studies
Additionally, you'll receive specific instructions to cease all food and drink consumption by a set time before your operation. It's crucial to adhere to these guidelines to ensure the procedure can proceed as planned.
Furthermore, making arrangements for your discharge, post-discharge living situation, and transportation during this stage is advisable to facilitate a smoother recovery process after the operation.
Surgical Procedure and Immediate Postoperative Care:
Surgical Procedure and Immediate Postoperative Care:
• Open Heart Surgery: In this approach, the surgeon opens up the chest cavity with a significant incision across the breastbone. The heart's activity is temporarily halted, and a heart-lung bypass machine assumes the role of the heart and lungs, facilitating breathing and blood circulation. The aortic valve is then either repaired or replaced, followed by the surgical wound being closed.
• Minimally Invasive Surgery: Should your medical condition permit and your surgeon deems it appropriate, a smaller incision is made in the chest wall to conduct the aortic valve repair or replacement. This technique is favored for its benefits, including a reduced risk of infection, shorter stays in the hospital, and a quicker recuperation period.
• Percutaneous or transcatheter aortic valve replacement: A catheter is placed into one of the great arteries for patients who are not healthy enough to undergo major surgery. The artificial aortic valve advanced through this catheter replaces the diseased aortic valve. Or a small incision is made on the rib cage to go the catheter directly into the heart. Your doctor will decide whether you are a good candidate for this procedure.
Three types of valves can be used for valve replacement surgeries: biological, homograft, and mechanical valves. In this regard, you can ask your surgeon for details and each type of valve's superior and inferior features.
Aortic valve replacement surgery is conducted under general anesthesia, ensuring you remain pain-free throughout the procedure, which typically spans several hours.
In the case of open heart surgery, your breastbone is realigned and secured with wires, while incisions in your chest are stitched up with sutures that naturally dissolve over time.
Following the completion of the surgery, you will be moved to the intensive care unit (ICU) for continuous, detailed monitoring. While in the ICU, careful attention will be paid to all vital signs, including your heart rate, blood pressure, respiratory rate, and other critical indicators. During this initial recovery phase, assistance with breathing is provided via a tube placed in your throat.
Once your monitoring in the intensive care unit concludes, you will be moved to a regular patient room. Following several days of observation there, you will be prepared for discharge. Prior to your departure from the hospital, your postoperative medications will be organized and prescribed. Additionally, you will receive guidance on various post-surgery considerations, including when to resume work, daily activities, exercise, and aspects of your personal life.
It is crucial to attend scheduled follow-up appointments with your surgeon before leaving the hospital.
Should you notice any warmth or redness along your incision, develop a fever, or encounter any symptoms that might be related to the surgery after you've been discharged, it's imperative to contact your surgeon without delay.
Results
It's important to understand that recovery will not be instantaneous and will involve adhering to specific precautions.
Achieving lasting outcomes hinges on following your doctor's medication instructions and embracing recommended lifestyle changes. For smokers, cessation is crucial, along with maintaining a healthy body weight and managing your blood pressure, glucose levels, and cholesterol effectively. Additionally, your doctor may advise participating in a cardiac rehabilitation program tailored to your needs post-surgery, which will include designated exercises to aid in your recovery from valve repair or replacement.
In terms of your health, you must attend follow-up visits on pre-scheduled dates and follow the suggestions made at each visit.
