Newer Heart Valve Surgery Options
One important reason to track any possible valve disease-related symptoms and get regular check-ups especially as we age is to ensure any developing valve problems can be identified and treated as soon as possible.
Medications can be prescribed to increase the hearts ability to pump blood which may help compensate for a valve that isnt working correctly. However, a diseased heart valve is a mechanical problem that cant be fixed with medication alone. Surgery is often needed to repair or replace the damaged valve. Untreated valve disease may lead to decreased heart function and limit future treatment options. Its important to discuss any symptoms with your health care provider.
Aortic Valve Balloon Valvuloplasty
Aortic valve balloon valvuloplasty involves passing a catheter through a large blood vessel and into the heart. A balloon is then inflated to open up the narrowed aortic valve.
This can prevent the need for open-heart surgery, although, in adults, surgery is still the first treatment choice.
The National Institute for Health and Clinical Excellence has recommended that aortic valve balloon valvuloplasty should only be used in people who are not suitable for traditional open surgery. It can also be used as a short-term treatment in babies and children until they are old enough for valve replacement.
The main drawback with this type of treatment is that the effects usually only last around 2 to 3 years. After this, further treatment is required.
How Do I Get Ready For An Open Aortic Valve Replacement
As you plan for the surgery, you and your healthcare provider will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve.
- Biological valves are made mainly from pig, cow, or human heart tissue. Biological valves dont last as long as mechanical valves but have less risk for blood clots.
- Mechanical valves are man-made. People with mechanical valves need to take blood-thinning medicines for the rest of their lives because of the risk for blood clots. Mechanical valves also have an increased risk for infection.
Talk with your healthcare provider about how to prepare for your upcoming surgery. Remember the following:
- Avoid eating or drinking anything after midnight before your surgery.
- Try to stop smoking before your operation. Ask your doctor for ways to help.
- You may need to stop taking certain medicines before your surgery. Follow your healthcare providers instructions if you usually take blood-thinning medicine like warfarin or aspirin.
You may arrive at the hospital the afternoon before your operation. This is a good time to ask any questions you have about the procedure. You may need some routine tests before the procedure to assess your health before surgery. These may include:
- Chest X-ray
- Coronary angiogram
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Recovery From Surgical Heart Valve Replacement
In the ICU, the staff will keep a close watch on your heart rate, temperature, blood pressure, and other vital body signs. You may feel a little uncomfortable because of all the monitoring equipment attached to you. The nurses will try to keep you as comfortable as possible. Friends and family are usually welcome to visit you.
When intensive care monitoring is no longer needed, you’ll be moved to a regular hospital room. Typically, you may be in the hospital for three to 10 days, depending on how quickly you recover.
Benefits Of Avoiding Open
Aortic stenosis occurs when the opening of the hearts aortic value narrows. This narrowing hinders blood flow, causing chest pain, shortness of breath, fatigue, and fainting. Up to 1.5 million people in the United States have aortic stenosis, and it interferes with everything from taking a walk to playing with grandchildren. Aortic stenosis typically requires valve replacement when the disease becomes severe. Most people with aortic stenosis once needed open-heart surgery to replace their valve, but another option called transcatheter aortic valve replacement offers a minimally invasive alternative that can have significant benefits compared to surgery: faster recovery time, less pain, and lower risk of complications. TAVR was only approved to treat patients with an intermediate or high risk of complications from open-heart surgery, but recently, it was approved to include low-risk patients. Today, anyone with severe aortic stenosis may be a candidate for TAVR.
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Guidelines For Aortic Valve Replacement
As long-term data on the survival and quality of life of people following valve replacement have become available, evidence-based guidelines for aortic valve replacement have been developed. These help healthcare professionals decide when aortic valve replacement is the best option for a patient. Two widely accepted sets of guidelines used by surgeons and cardiologists are the American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease, and the European Society of Cardiology and the European Association for CardioThoracic Surgery Guidelines for the management of valvular heart disease.
What Is The Risk Of Aortic Valve Surgery
At Cleveland Clinic, the overall risk of death associated with surgery for isolated aortic valve replacement is less than 1%, compared with The Society of Thoracic Surgeon’s benchmark of 2.4%. Mortality for minimally invasive “j” incision isolated aortic valve replacement is even lower and mortality for minimally invasive isolated aortic valve repair is also extremely low even for the David valve preserving procedure. Past history of heart surgery, your age, co-existing organ disease , or other conditions that require surgical treatment will affect your individual risk. Ask your doctor about your surgical risk
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What Is Surgical Aortic Valve Replacement
Surgical aortic valve replacement is the treatment of choice for many patients diagnosed with severe aortic stenosis. The University of Michigan Frankel Cardiovascular Center team performs more SAVR procedures than any other hospital in the state.
Other, less invasive options for aortic valve replacement using a catheter procedure are available for certain patients, but surgical replacement of the aortic valve is often the most appropriate and safest procedure for some.
The Frankel CVC team considers the type of aortic disease a patient is suffering from as well the patients overall health in determining the most appropriate surgical procedure. This may include open heart surgery with a standard type of incision, or open heart surgery in which a smaller incision is made. In both procedures, the diseased valve is removed and the patient is implanted with a replacement valve.
A patient may need aortic valve surgery to replace the aortic valve in the heart if he or she is diagnosed with:
- Aortic stenosis, a condition in which the aortic valve does not open fully, resulting in reduced blood flow out of the heart.
- Aortic regurgitation, a condition in which the aortic valve does not close all the way, resulting in blood leaking back into the heart.
About the graphic: U-M Health’s 3-star rating for isolated aortic valve replacement is the Society of Thoracic Surgeons’ highest possible rating for the procedure.
Symptoms Of Aortic Valve Disease
Sometimes, if you have a problem with your aortic valve, you may not experience any symptoms until later on in the disease process. Any symptoms you feel occur because your heart cannot pump blood around your body efficiently. Symptoms you may have include:
- chest pain brought on by physical activity this is caused by your heart having to work harder due to restricted blood flow through your aortic valve
- shortness of breath at first you may notice this only when you exercise, but later you may experience this even when resting
- dizziness or light-headedness this is caused by the obstruction of the flow of blood from your heart to the rest of your body
- loss of consciousness this is also a result of reduced blood flow caused by the obstruction in your heart
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Details About The Studies
Two separate studies presented at the March 2019 American College of Cardiology conference supported similar findings: After one to two years of follow-up, TAVR outcomes were found to be similar to surgical aortic valve replacement outcomes in patients with aortic stenosis and low surgical risk.
In a TAVR procedure, a doctor can repair a diseased aortic valve without open heart surgery. The new heart valve is inserted via catheter through an incision in the groin, guided inside the affected valve, and expanded to reopen it. Approximately half of patients with aortic stenosis today are considered to have low surgical risk hence the excitement about those studies.
Medtronics trial studied the CoreValve platform. Researchers assessed two endpoints after two years: death and disabling stroke. This study found that 5.3 percent of patients who had TAVR died or suffered a disabling stroke compared to 6.7 percent of patients who had surgery. All-cause mortality rates were the same for both procedures. Disabling stroke affected 1.1 percent of TAVR patients and 3.5 percent of surgery patients. The mean age of participants was 74.
The two competing medical device companies have both since published two-year results, which are in line with the initial reported findings.
How Is Repair Or Replacement Of An Aortic Valve Accomplished
There are a number of ways to repair or replace a damaged or defective aortic valve. The two primary matters your surgeon will consider are whether your valve can be repaired or must be replaced, and which surgical approach will work best.
In certain limited circumstances, especially if your valve is leaky rather than blocked, it may be possible to repair it using small tissue patches on the flaps of the valve.
In most cases of surgery on a damaged aortic valve, however, replacement rather than repair will be the most advisable option. There are two primary kinds of replacement valves. Factors such as your age and the overall state of your health will affect which kind is most appropriate:
- Mechanical valves are made of very durable artificial materials, including titanium, carbon, polyester, Dacron and Teflon. They are typically very long-lasting however, use of a mechanical valve usually requires patients to take blood-thinning medication for the rest of their lives.
- Biological valves, also known as tissue valves or bioprosthetic valves, are made of animal tissue, often from a pig or a cow. They do not usually necessitate the lifelong use of blood-thinning medication however, biological valves have a limited life span, averaging 10 to 20 years, so a second valve replacement operation may be required in the future. Biological valves are used in the majority of aortic valve replacement operations.
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Preparing For Your Aortic Valve Surgery
Before having an aortic valve replacement, you will attend a pre-admission clinic. Here, you’ll be seen by a member of the team who will look after you in hospital.
At the clinic, you will have a physical examination and will be asked for details of your medical history.
Any investigations and tests that you need will be arranged. For example, these will include a blood test or an X-ray. This is a good time to ask questions about the procedure, although you can discuss your concerns with your doctor at any time.
You will be asked if you are taking any tablets or other types of medication. These might be prescribed by your GP or bought over-the-counter in a pharmacy. It helps if you bring details with you about any medication you are taking, for example by bringing the packaging with you.
You will be asked about any previous anaesthetics you have had, and whether you had any difficulties or side effects with these, such as nausea. You will also be asked whether you are allergic to anything. This is to prevent you having an allergic reaction to any medication you might need.
If you smoke, you will be advised to stop. Quitting smoking will lower the risks of complications occurring after surgery, such as chest infection or blood clots.
It is likely you will be in hospital for 5 to 7 days, so you will need to make some practical preparations. These include bringing clothes, toiletries and any equipment you use, such as a walking stick or hearing aid.
What Happens During An Open Aortic Valve Replacement
Check with your doctor about the details of your procedure. In general, during your open aortic valve replacement:
- You will be given anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards you wont remember it.
- The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
- Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
- The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
- Your surgeon will remove your current heart valve and replace it with a new valve.
- The surgery team will remove the heart-lung machine.
- The team will wire your breastbone back together.
- The team will then sew or staple the incision in your skin back together.
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Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation is a relatively new procedure. It involves accessing the aortic valve through the femoral artery or vein , or through a small surgical incision in your chest.
A balloon catheter is guided into the left ventricle chamber in your heart, and it is used to position the prosthetic valve over the old one.
TAVI may be used if someone is too frail to cope with the stress of standard valve replacement surgery, for example due to their age or another illness.
While it is not as effective as traditional open surgery, a TAVI does offer a marked improvement in survival for people with severe aortic valve diseases. One study found that this type of treatment could half a persons risk of death.
However, there is around a 1 in 16 chance of having a stroke in the first year after a TAVI.
Why Might I Need A Minimally Invasive Aortic Valve Replacement
This procedure may be needed if your aortic valve is working poorly. This may happen if you have aortic valve stenosis or aortic valve regurgitation.
- In aortic stenosis, the valve is unable to open fully. This means less blood is able to exit the heart.
- In aortic regurgitation, the valve is leaky. Some blood leaks back through the valve instead of moving out to the rest of the body.
In both of these cases, you may need to have your aortic valve replaced. A poorly working aortic valve may lead to symptoms such as:
- Shortness of breath
- Passing out
- An unpleasant awareness of your heartbeat
If these symptoms continue, surgery may be needed. Your healthcare provider may recommend the surgery even if you dont have significant symptoms. Surgery is most effective before symptoms become severe.
Both aortic stenosis and aortic regurgitation can happen because of general aging of the valve. Other causes of aortic valve disease include:
- Heart birth defects
- Bacterial infection of the heart valve
- Tear of the aorta
- Aortic aneurysm
- Certain genetic conditions
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Who Is A Candidate For Aortic Valve Replacement
If you suffer from moderate to severe aortic valve regurgitation, aortic valve stenosis or congenital heart disease, you may be a candidate for an aortic valve repair or aortic valve replacement.
If left untreated, aortic valve disease can lead to heart attack, heart failure, stroke or sudden cardiac arrest.
When Is Aortic Valve Replacement Required
Like most forms of heart disorders, there are different degrees, or levels, of aortic valve disease which determine the need for surgical treatment. Patients with mild and moderate forms of aortic stenosis and aortic regurgitation do not typically require surgery. However, if a patient is diagnosed with a severe form of aortic valve disease, a repair or replacement is often recommended.
It is critical to note that not all patients experience symptoms prior to aortic valve replacement surgery. Patients can be asymptomatic — without symptoms — and still suffer from severe aortic valve disease. It is for this reason that patients diagnosed with aortic valve disease, or even a heart murmur, should actively monitor the condition of their heart over time via regular echocardiograms.
Without an appropriately timed surgery, the patient’s heart can experience major complications. The most common complication is an enlarged heart muscle which can be a precursor to congestive heart failure. just prior to my aortic valve replacement).
It should also be noted that aortic valve replacement surgery may be needed if the valve leaflets, which control the flow of blood through the heart, suffer from severe aortic valve calcification. Finally, a congential defect, known as a bicuspid aortic valve, may trigger the need for an aortic valve replacement. For me, my bicuspid aortic valve created a situation in which I suffered from both aortic stenosis and aortic regurgitation simultaneously.
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British Columbia Specific Information
There are several different types of heart valve disorders and many different treatments available. Treatments could include lifestyle changes, medication, or surgery. To learn more about heart valve disorders and treatments, visit the Heart and Stroke Foundation – Valve Disorders.
In some cases, a blood thinner may be prescribed as part of your treatment. Blood thinners are medicines that help prevent blood clots. If you are taking a blood thinner, always talk to your health care provider before you buy any over the counter medicines.
For more information you may also call 8-1-1 to speak to a registered nurse or pharmacist. Our nurses are available anytime, every day of the year and our pharmacists are available every night from 5:00 p.m. to 9:00 a.m.