What is Aortic Valve Replacement: Overview, Benefits, and Expected Results

Definition and Overview

Aortic valve replacement is a procedure performed on patients with malfunctioning heart valves. Doctors recommend it if the damaged aortic valve can no longer be repaired and is causing complications such as regurgitation. The procedure aims to replace the damaged valve with an artificial valve.

In the past, aortic valve replacement is only performed through highly invasive open-heart surgery. However, due to recent advances in technology and in the field of cardiology, the procedure can now also be performed using minimally invasive methods or those that do not require a huge incision in the chest.

Who Should Undergo and Expected Results

Aortic valve replacement surgery is recommended for patients whose aortic valves are damaged beyond repair or those who are suffering from:

• Aortic stenosis, in which the aortic valve becomes narrowed leading to the obstruction of blood flow from the heart

• Aortic regurgitation, in which the aortic valve leaks resulting in blood flowing back to the heart

If left untreated, aortic valve problems may eventually lead to heart failure. Thus, doctors usually recommend valve replacement following diagnosis to prevent the condition from worsening and save the patient from potentially life-threatening complications.

Following an aortic heart valve replacement, the artificial valve is expected to function the same way as the original heart valve. The patient is also expected to have a close to normal life expectancy. The risk of heart failure as well as other symptoms and cardiac issues caused by the condition are also expected to be resolved.

How is the Procedure Performed?

In an aortic valve replacement procedure, the damaged valve is replaced with an artificial heart valve, which could be:

• Biological – These valves tend to last between 10 to 20 years. They do not require long-term blood thinning medications but may need to be eventually replaced.

• Mechanical – These valves are made of man-made synthetic materials, the most common of which are titanium or carbon. They last longer than biological valves but require patients to take blood thinners for the rest of their lives.

As for the method in which the procedure is carried out, options include open-heart surgery and minimally invasive methods (minimally invasive aortic valve replacement).

• Open-heart procedure (mechanical aortic valve replacement) – An open-heart procedure to replace a faulty or damaged aortic valve is performed under general anaesthesia and involves making a large cut (about 25cm long) in the chest to gain access to the heart. The heart is then stopped with its function turned over to a heart-lung bypass machine. The surgeon then removes the damaged aortic valve and manually replaces it with a new artificial one. The heart is then restarted and the chest incision is closed with stitches. Open-heart aortic valve replacement surgery usually takes a few hours and the patient has to stay in the hospital for about a week. The whole recovery period may take up to 2 to 3 months.

• Percutaneous aortic valve replacement or transcatheter aortic valve replacement (TAVR) – Percutaneous or transcatheter aortic valve replacement surgery replaces a faulty or damaged aortic valve without making a large incision in the chest. It is usually performed using at least one small cut (about 2-3 inches) on the right chest near the breastbone. These minimally invasive surgeries take less time than open-heart surgery. They work by wedging a replacement valve into the place of the original valve. The artificial valve, which is fully collapsible, is delivered via a catheter. Once in place, the valve is expanded, an action that automatically pushes the damaged valve out of the way.

• Transfemoral approach – The transfemoral approach is an alternative method used to perform transcatheter aortic valve replacement surgery. In this method, the catheter enters the body through the femoral artery (or the large artery in the groin) instead of through the chest.

• Robotic-assisted heart valve surgery – This procedure can be performed through 2-4 tiny cuts in the chest using a special computer that controls robotic arms. The procedure is guided by a 3D view of the heart and the aortic valve displayed on a computer.

Following the procedure, the surgeon will place flexible tubes around the heart to prevent fluid build up in the treated area.

Since transcatheter aortic valve replacement procedures and other advanced techniques are fairly new, they are often only used for high-risk patients who are not healthy enough to undergo traditional open-heart replacement surgery.

Possible Risks and Complications

Potential aortic valve replacement complications include the following:

• Wound infections (especially for open heart surgery with large chest incisions)

• Lung or bladder infection

• Heart valve infection (endocarditis)

• Stroke

• Blood clot

• Irregular heartbeat or arrhythmia

• Reduced kidney function

Patients are also faced with the common risks of general anaesthesia, such as breathing problems and allergic reactions.

A transcatheter aortic valve replacement procedure is less risky as there is less pain and reduced blood loss after the procedure. The recovery period is also shorter than that of open-heart surgery.

Patients who have undergone aortic valve replacement surgery may need another surgery in the future. The length of time in between said procedures will depend on the type of artificial heart valve used during the first surgery.

There is also a small chance that an artificial heart valve will not work as expected after an aortic valve replacement procedure. Thus, patients are advised to follow their after-care plan closely and have their artificial heart valve checked regularly to make sure it is working properly.

References:

• Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, et al. “Surgical or transcatheter aortic valve replacement in intermediate risk patients.” The New England Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMoa1700456

• Svensson LG. “Aortic valve replacement: Options, improvements, and costs.” Cleveland Clinic Journal of Medicine. 2013 April;80(4): 253-254. http://www.mdedge.com/ccjm/article/95959/cardiology/aortic-valve-replacement-options-improvements-and-costs

• Malas T, Ruel M. “Cardiac Surgery: Current status of aortic valve replacement.” Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada. https://www.omicsonline.org/cardiac-surgery-current-status-of-aortic-valve-replacement-2161-1076.S3-001.php?aid=8370

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**What is Aortic Valve Replacement?**



Aortic valve⁢ replacement (AVR) is a⁢ surgical procedure to replace a damaged or⁢ diseased aortic valve ​with a functioning artificial⁣ valve. The aortic ⁢valve is the heart ⁣valve that regulates blood ⁤flow from the left ‍ventricle⁢ to the aorta, the body’s largest ⁤artery.



**Overview of Aortic Valve Replacement**



* **Diagnosis and Evaluation:** Before recommending AVR, a doctor will‌ conduct a⁣ thorough ⁤evaluation to determine the ‌severity of ⁣the valve ⁣dysfunction and assess the patient’s overall health. Tests may ‍include echocardiogram, chest X-ray, and blood work.

* **Surgical Options:**​ AVR can be performed through various surgical approaches, including:

‍ * Open-heart surgery

‌ ⁤ * Minimally invasive surgery‌ (thoracotomy, ⁢subxiphoid)

⁤* ‌Transcatheter aortic valve ⁣replacement (TAVR)

* **Valve⁤ Types:** Artificial valves used in AVR‍ can​ be mechanical or⁣ biological. Mechanical valves​ are durable‌ but⁤ require lifelong anticoagulant therapy, while biological valves ⁣are⁤ less durable but do not require anticoagulants.



**Benefits of Aortic Valve Replacement**



* **Improved⁤ Blood Flow:** Replaces the malfunctioning valve,‍ restoring blood flow to the body’s ⁣organs and tissues.

* **Relieved⁤ Symptoms:** Addresses symptoms such as shortness of breath, chest⁤ pain, and fatigue associated with valve ⁤dysfunction.

* **Enhanced ⁣Quality⁣ of Life:** Restores the heart’s function, improving daily activities and overall well-being.

* **Increased Life Expectancy:** Timely AVR can significantly improve the life expectancy of patients with severe valve disease.



**Expected Results‍ After Aortic Valve Replacement**



After AVR, patients can expect:



*‌ **Recovery Time:**⁣ The‌ recovery​ time varies depending on ⁤the surgical approach, but generally involves several days in the hospital followed by several weeks of rest and rehabilitation.

* **Valve Function:** The‍ replacement valve will immediately‍ function to regulate blood flow, and the benefits should be noticeable within the first few days.

* **Monitoring and Follow-Up:** Ongoing monitoring and follow-up appointments are crucial to ensure⁢ the valve’s proper function and overall patient well-being.

* **Return to ⁤Activities:** Most⁤ patients can gradually return to normal ⁤activities within 2-3 months, but some restrictions may ⁤apply.



**Additional Information**



* AVR⁤ is⁢ a major heart surgery, but the ⁤success rate is high in experienced centers.

* The choice ⁣of ‍valve type and surgical approach depends ​on factors such as the patient’s age, health, and preferences.

* ​Ongoing research focuses on ⁣developing⁣ less invasive and more durable valve technologies.