Aortic Valve Surgery
Valve repair and replacement is performed to improve the blood flow through a faulty valve. Importantly, the aortic valve can be repaired as well as the more commonly performed replacement.
The problem
Patient Reference Material
In healthy patients, blood returning from the lungs is pumped into the left atrium (the left upper chamber of the heart) and through the mitral valve into the left ventricle (the left lower chamber of the heart). From the left ventricle, the blood is then pumped through the aortic valve and out to the rest of the body, via the aorta.
In the hearts of patients with aortic valvular disease, the aortic valve doesn't open or close properly. Patients with valves that interfere with adequate blood flow may notice a number of symptoms that compromise the quality of their daily lives, including:
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Fatigue
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Breathlessness
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Shortness of breath
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Trouble breathing during heavy exercise
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Angina
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Syncope
Valve disease compromises blood flow in one of two ways:
Stenosis
In stenotic valves, the leaflets that make up the valve stiffen. This narrows the valve opening and prevents smooth blood flow. This can cause dangerous increases in pressure within the heart and lungs. The left ventricle will try to accommodate this narrowing by thickening, and with time this will lead to detrimental enlarging of the heart.
Regurgitation
Regurgitation occurs when one or more of the leaflets enlarges to the point the valve can no longer close with a tight seal, allowing blood to flow back through the valve once its been pumped through.
There are a number of causes for this kind of wear and tear on the valve, including enlargement of the aorta(which acts as a "scaffold" for the valve), valve infections, and myxomatous degeneration.
How are valve repairs performed?
The procedure for valve repair depends on the particulars of a patient's case. For example, a patient with an aneurysm of the ascending aorta may develop insufficiency which could be treated with repair of the aneurysm itself. Insufficiency associated with dilated aortic roots can sometimes be fixed with a "valve sparing" root replacement.
In all cases, surgeons at Montefiore-Einstein Heart Center offer patients the most minimally invasive approach available. Depending on the circumstances, Montefiore's surgeons will use breast bone incisions that are up to two-thirds smaller than the traditional cut.
Repair vs. replacement
Although Montefiore-Einstein offers cutting edge procedures for the full spectrum of mechanical and biological valve replacement, surgeons at Montefiore-Einstein are dedicated to valve repair when appropriate.
When the valve is repaired, patients maintain their own tissue and don't need to take blood thinners. This is an attractive option for young women planning to become pregnant. Montefiore-Einstein currently is participating in a national clinical trial evaluating the efficacy of valve sparing procedures in patients with Marfan Syndrome.
Protecting your valves during routine medical procedures
Infections that affect valve function cross every social and economic line—they can happen to anyone. Patients who have existing valve conditions are at risk for contracting an infection during routine dental, OB/GYN, and urology procedures where there is a risk of bacterial release into the bloodstream.
Patients with existing valve conditions should talk to their doctors about taking antibiotics before these routine procedures. For example, your doctor may prescribe an oral antibiotic to be taken prior to dental work.
