When aortic valve disease develops, surgical replacement is recommended. Surgical intervention can reduce symptoms and improve life expectancy.
In the standard procedure, the full breastbone is divided to access the heart (called a sternotomy). A minimally invasive approach uses smaller incisions.
The surgeon will select the best treatment option for you depending on your heart and chest anatomy and whether you need a mechanical or tissue valve.
Costs
Surgical repair of the aortic valve is needed to reduce symptoms and improve quality of life. A standard aortic valve replacement (AVR) requires the surgeon to make an incision in your breast bone and attach you to a heart-lung machine that will act as your body’s heart and lungs while the operation is performed.
Alternatively, the surgery can be performed through a minimally invasive approach that avoids the need for the full-sternotomy. Minimally invasive AVR via the ministernotomy or anterior right mini-thoracotomy approach offers excellent clinical outcomes, with a similar short- and long-term mortality rate as traditional isolated aortic valve replacement.
Your doctor will also discuss the type of valve you should have replaced. You may have a biological valve, made of pig, cow, or human heart tissue, or a mechanical one that is man-made and does not require you to take blood-thinning medication. The decision is based on your age, lifestyle, and whether you want to live with a biological or mechanical valve for the rest of your life.
Procedures
When a person has a faulty aortic valve, surgery can repair or replace it. The Smidt Heart Institute offers minimally invasive surgery, which has fewer complications and shorter hospital stays than open-heart surgery.
The aortic valve is located between the heart and the large blood vessel called the aorta. The aortic valve opens to allow blood to flow out of the heart, and then closes to keep blood from flowing back into the heart. If the aortic valve doesn’t open properly or close completely, it can cause a condition called aortic stenosis.
UT Southwestern is one of only a few hospitals in the United States where surgeons can repair or replace an aortic valve without cracking the chest (sternotomy). With this technique, surgeons make a 2-inch incision between the ribs instead of dividing the entire breastbone (called a median sternotomy). During surgery, patients are put on a heart-lung machine. However, it is not uncommon for the surgeon to switch to a sternotomy if a complication arises.
Recovery
Minimally invasive aortic valve replacement has become a feasible approach to treat different aortic pathologies with limited procedural trauma. Unlike the standard procedure, which requires a full division of the sternum to access the heart (called a median sternotomy), minimally invasive techniques have reduced hospital stays, complications, and wound infections. They also reduce the need for mechanical ventilation and shorten recovery time.
During a minimally invasive operation, your surgeon uses small incisions in the chest through which he or she reaches the heart with tools and a camera. Depending on your case, the surgeon may use robot-assisted surgery or thoracoscopic surgery.
This technique allows patients to be discharged a day sooner than with traditional open heart surgery, which often results in a more lengthy hospital stay and a slower recovery. It is important to choose a center that has experienced surgeons and a surgical team capable of performing this procedure.
Insurance
If your aortic valve can’t open properly (stenosis), surgery may be needed to repair it. Your doctor can also replace your aortic valve with an artificial one — made from cow, pig or human heart tissue (biological tissue valve), or one from another person (autograft).
If you aren’t a candidate for traditional open-heart surgery because of other health problems, your doctor can offer less invasive options. In these procedures, surgeons make small incisions or use a robot-controlled arm to do the operation. You may spend a few days in the hospital and recover more quickly than with traditional surgery.
If you need to have your aortic valve replaced, your life insurance provider will want to know the details of the procedure and how it has affected your recovery. Your doctor will discuss all of your options, including their risks and benefits. You can also talk with your insurance agent about the best way to cover these costs.
