Individuals living with heart valve disease may undergo surgery to correct aortic stenosis and regurgitation. Unfortunately, traditional surgical approaches typically employ hard-wearing mechanical valves made of synthetic materials which put patients at increased risk of blood clots requiring them to take life-long blood thinners.
A recent advancement offers an effective alternative. It involves implanting a biological valve made of pig or cow tissue into your heart that does not increase risk for blood clots, offering greater relief without increasing them further.
What is the procedure?
Faulty aortic valves prevent blood from flowing efficiently from your heart to the main blood vessel in your body known as the aorta, leading outward. This can result in shortness of breath, low blood pressure and fainting; left untreated it could even lead to heart failure and attack; surgery can improve blood flow, reduce symptoms and lessen risk.
Aortic valve disease typically develops with age or at birth (congenital). Two main forms of Aortic Valve Disease include Aortic Stenosis and Regurgitation. Stenosis occurs when valve leaflets don’t open wide enough, narrowing the opening. This condition can be brought on by infection (endocarditis), rheumatic fever resulting from antibodies produced to fight throat infections such as Strep Throat attacking valves directly, as well as factors like loose leaflets, holes in valves or an abnormal congenitally deformed Aortic Valve.
When replacing an aortic valve is necessary, either traditional open heart surgery involving cutting the chest bone (sternotomy) or minimally invasive catheter-assisted valve replacement (transcatheter aortic valve replacement or TAVR) are options available to you. Minimally invasive surgeries may result in shorter hospital stays, less discomfort and faster recoveries.
Under the Ross procedure, your surgeon replaces both of your aortic valves with ones made from human donors while leaving behind a healthy pulmonary valve from yourself that controls how blood flows to your lungs – thus decreasing wear-and-tear issues and eliminating long-term need for blood-thinning medications following surgery.
Some patients can control their symptoms with medications alone and avoid surgery on their aortic valve. When symptoms persist or become life-threatening, however, having it repaired or replaced could restore an active life and drastically decrease heart disease risk – consult a cardiologist if this procedure is right for you.
What are the risks?
The aortic valve controls blood flow between the heart and aorta. Its role can become compromised when narrowed by narrowed or leaky passageways known as stenosis or regurgitation; symptoms include fatigue, shortness of breath and abdominal pain; heart attacks, congestive heart failure and stroke can result from this disease.
A recent analysis from the Society of Thoracic Surgeons National Database examined data pertaining to patients who underwent either surgical or transcatheter aortic valve replacement procedures (SAVR or TAVR). Researchers examined variables linked with hospital morbidity and mortality.
They found that certain pre-surgical factors are linked with higher rates of death after surgery, including being in NYHA functional class III-IV and having an elevated LVMI on univariate analysis. A low EF was also indicative of higher risks following surgery.
Anesthesia complications, age and coexisting medical conditions such as peripheral vascular disease, chronic renal insufficiency or previous cerebrovascular events or aortic root dilation all pose additional risks associated with aortic valve surgery that should be considered when selecting the optimal course for each individual patient. A surgeon must consider all risks when making their decision regarding which surgery option would be most suitable.
As part of their risk evaluation for an aortic valve replacement procedure, surgeons must also assess whether their patient should opt for mechanical or tissue valves. Tissue or biological valves made from porcine products have become popular over recent years due to their durability and reduced need for lifelong blood thinners; however, over time these valves may deteriorate and need ongoing expert surveillance.
Mechanical valves offer minimal risk of structural deterioration and can eliminate the need for lifelong anticoagulation therapy; however, they do introduce an ongoing risk of bleeding and thromboembolism that cannot be ignored.
What is the recovery like?
Heart valve disease occurs when the natural valve between the aorta, the main artery of the body, and the left ventricle (the chamber that pumps blood out of the heart) becomes dysfunctional. This could be caused by congenital heart disease present at birth or discovered later, or it could be secondary to other medical issues. Once diagnosed with this issue, healthcare teams can discuss potential treatment options with them; oftentimes people require their aortic valve repaired or replaced at some point during their lives.
When repair or replacement surgery is necessary, several different surgical procedures may be used to address it. Which procedure will be chosen will depend on each patient’s unique needs and risk factors as determined by a multidisciplinary team that includes cardiac surgeons and cardiologists; repairs or replacement will only occur if their health care provider believes doing so will allow for an active lifestyle without complications related to heart valve disease.
Faulty aortic valves can be repaired using surgery or less invasive procedures, with both traditional open-heart surgery involving making an incision in the chest (sternotomy), while less invasive techniques like balloon valvuloplasty involve inserting a small, hollow tube through blood vessel catheter in your groin to your heart, with its tip being threaded onto it before inflating a balloon to widen any narrowed valves.
If repair is no longer an option, a surgeon will replace the faulty valve with a new one using either mechanical or biological technology – at Cleveland Clinic around 80% of aortic valve replacement surgeries are conducted with biological valves made up of tissue from other species such as pig or cow tissue.
Recovery after an aortic valve operation may take weeks to months, depending on whether the valve was repaired or replaced. Your health care team will let you know when it is safe for you to resume daily activities such as work and exercise; additionally, regular checkups will ensure your aortic valve continues working correctly.
What is the outcome?
Undergoing any heart surgery involves risks, but most individuals who undergo repair or replacement surgery for aortic valve disease usually enjoy normal life expectancies afterwards. But leaving serious problems untreated could have serious repercussions; to ensure you receive optimal care it’s essential that you speak to your healthcare provider about which form of surgery would best meet your needs and what outcomes to anticipate from it.
Balloon valvuloplasty and surgery can both help widen an aortic valve. Replacement surgery often offers better long-term results; most replacement valves made from hard-wearing synthetic materials often cause blood clots that require patients to continue taking blood-thinning medication indefinitely; other patients may benefit from having biological valves made from animal tissue that don’t require blood thinning medication for replacement purposes.
Some surgical treatments for aortic valve disease are less invasive than open heart surgery and use smaller incisions to limit blood loss, pain, and length of hospital stay. Your surgeon will review your diagnostic tests to decide which form of aortic valve surgery would best meet your needs.
Some older patients can undergo aortic valve replacement using traditional open heart surgery techniques that involve creating larger incisions to gain access to the chest. This procedure usually requires general anesthetic and must take place over at least one day in an intensive care unit.
Recent research compared TAVR with traditional open heart surgery among candidates for both. Researchers concluded that when performed by experienced surgeons and centers, TAVR results are comparable to traditional open heart surgery in young and middle-aged adults suffering from aortic valve disease.
