Aortic Valve Replacement.

Aortic valve replacement surgery  is indicated in diseases of the aortic valve such as aortic valve regurgitation and aortic valve stenosis. It is an open heart surgery wherein the defective aortic valve is replaced by an artificial one. The artificial heart valve can either be a mechanical valve or a tissue valve.

Aortic Replacement Valves.

1) Tissue Heart Valves.

The tissue heart valve is made of animal tissue such as the heart valve tissue or the pericardial tissue, which is previously treated to prevent rejection and calcification. Tissue valves tend to wear out in 15 to 20 years in less active people. In younger active people, it tends to wear out faster. Young people are therefore advised to have a mechanical valve replacement to prevent risk of another surgery to replace the faulty valve.

2) Homografts.

Sometimes, homografts are used. Homografts are valves which are recovered after the person who has donated it, dies.

3) Mechanical Heart Valve.

Mechanical heart valves or prosthetic aortic valves are made of mechanical parts and well tolerated by the body. They are usually bicuspid or bileaflet. Mechanical valves are sturdy and last a lifetime. Re operations with mechanical valves are uncommon. The disadvantage is that the operated person has to be put on blood thinners (Warfarin is the drug commonly used) throughout life as there is increased risk of blood clot formation.

Aortic Valve Replacement Surgery Procedure.

• An incision is made in the center of the chest and the sternum (breast bone) is cut through.
• The pericardium is cut open to expose the heart.
• The patient is put on a heart lung machine which is also called the cardiopulmonary bypass machine. This acts as heart and lung functioning machine and is necessary because the heart has to be stopped to perform the operation. The heart lung machine breathes for the patient and also pumps blood to the body parts thereby keeping the patient alive.
• A cut is made in the aorta at the site of the aortic valve and a crossclamp is  applied to stop bleeding from the aorta.
• The defective aortic valve is then surgically removed and the artificial valve is sutured in its place.
• Once the new valve and aorta are sutured, the heart lung machine is removed.
• A transesophageal echocardiogram is usually done to see if the new valve is functioning properly. This is an ultrasound of the heart done through the esophagus.
• Pacing wires are put in place in case the heart requires pacing for normal beating of the heart.
• Drainage tubes are inserted to drain fluids from the chest and pericardium. These are removed within 48 hours.
• Pacing wires are usually kept in place till discharge from the hospital.

Transcatheter Aortic Valve Replacement.

Transcatheter aortic valve replacement or percutaneous aortic valve replacement is a procedure wherein the replacement valve is passed in a catheter up the femoral artery in the groin and up to the ascending aorta. It is a less invasive procedure and though the survival rate is equal the risk of stroke is higher.

Research in aortic valve replacement is trying to find ways on how the aortic valve can be replaced using a catheter and thereby avoid open heart surgery. This procedure has been approved in Europe but still under trails in the US. However it is found to be associated with higher incidence of stroke.

Common Complication of Aortic Valve Replacement.

Heart block is a common complication which then requires permanent insertion of a cardiac pacemaker.

Hospital Stay.

• 12 to 36 hours in ICU (intensive care unit).
• Hospital stay for 4 days after removal from ICU.

Recovery After Aortic Valve Replacement.

Full recovery from aortic valve replacement takes about 3 months in a healthy patient and without complications.

Patients are advised against lifting any heavy objects to avoid causing any damage to the sternum.

Risks of Aortic Valve Replacement.

Depending on the general condition of the patient and the skill of the cardiac surgeon, risk of death and serious complications is 1% to 3%.

Related posts:

1. Aortic Valve Anatomy, Function and Diseases.
2. Heart Valves.
3. What is Systole.
4. Heart Chambers.
5. Left Ventricle of the Heart.
6. Heart Murmur Grades, Causes, Symptoms, Diagnosis and Treatment.
7. What Does Heart Do|Function of Heart.
8. Heart Anatomy and Structure.