When the aortic valve becomes too diseased, surgical replacement is necessary to reduce symptoms and improve life expectancy. Traditionally, this requires a large opening in the breast bone (median sternotomy) and use of a heart-lung machine.
Today, there are minimally invasive options to traditional surgery. One of these is called mini-AVR.
How it works
The aortic valve opens so blood can flow out of your heart, and closes to prevent blood from flowing back into the heart. If the aortic valve is diseased, it may not open properly, causing reduced blood flow and symptoms, such as breathlessness or fatigue.
Surgery can replace or repair the aortic valve, depending on your medical condition and preference. At UT Southwestern, we offer minimally invasive surgical techniques to treat aortic valve disease.
With this approach, a surgeon can perform aortic valve replacement surgery through a 2 to 4-inch incision between your ribs without having to divide the entire breast bone (sternum), as in standard open-heart surgery. The patient’s heart is stopped during the procedure, and a heart-lung machine takes over its function while the operation is being performed.
The surgeon can use this technique to repair or replace a faulty aortic valve, as well as the mitral valve. It is important to discuss your options with your doctor, and your suitability for a minimally invasive approach will be assessed on an individual basis.
Pre-operative preparation
A large blood vessel, the aorta, separates the heart and body. A valve in the aorta opens to let blood flow out of the heart and then closes to keep blood from flowing back into the heart. A faulty aortic valve causes symptoms such as breathlessness or chest pain. Your surgeon can replace or repair the valve.
The surgeon makes a small cut in your chest (sternum) for this surgery. Your surgeon will also divide the muscles in your chest. This allows the surgeon to access your aortic valve and surrounding tissues.
Your doctor will discuss your surgical options with you. You may be able to choose between a mechanical or tissue valve. A mechanical valve is durable, but it requires you to take blood-thinning medication (warfarin) for life. A tissue valve may only last for 7-15 years, but it does not require warfarin. Your doctor will help you decide which type of valve is right for you.
Incisions
Many people are told that they are too old or frail to have traditional heart valve surgery. But the TAVR procedure allows them to have a less invasive procedure and recover in just a few days.
During the minimally invasive surgery, your surgeon will make smaller incisions between your ribs to reach the aortic valve and replace it with a new one. During this time, your surgeon will connect you to a heart-lung machine, which acts as your heart and lungs while the surgeon performs the operation.
During the aortic valve replacement procedure, your surgeon will replace the faulty aortic valve with a synthetic valve that will help prevent blood from flowing backward through the aorta. Your surgical team will then close the incisions and sew you up. You will remain in the hospital for a few days while your body heals. Your doctors and treatment team will review your recovery plan with you before you leave the operating room.
Recovery
UT Southwestern has developed several minimally invasive techniques that significantly reduce surgical time, recovery times and risks. Your doctor will determine the most appropriate method for you based on your age, heart condition and chest anatomy.
Your surgeon will make a 2- to 4-inch incision on your side or under your breastbone. Then, he or she will insert long instruments and a camera to repair or replace your faulty aortic valve.
In some cases, the surgical team may use a catheter-based procedure called transcatheter aortic valve replacement (TAVR). During this procedure, doctors insert a tube with a balloon through a blood vessel in your groin and use it to open a narrowed valve.
Your doctor will replace your aortic valve with a biological or mechanical valve. Biological valves are made from pig, cow or human heart tissue. They don’t last as long as mechanical valves, but they have a lower risk for blood clots. Mechanical valves last longer but require you to take blood-thinning medication, such as warfarin, for life.
