Aortic Valve Surgery
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Services and Treatments

Aortic Valve Surgery

Valve repair and replacement are performed to improve the blood flow through a faulty valve. It is important to note that the aortic valve can be repaired, in addition to the more commonly performed replacement.

Valve Disease: The Problem

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 does not 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:

  • Fatigue
  • Breathlessness
  • Shortness of breath
  • Trouble breathing during heavy exercise
  • Angina
  • 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. 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 it's 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 the Montefiore Einstein Center for Heart and Vascular Care offer patients the most minimally invasive approach available. Depending on the circumstances, our surgeons will use breast bone incisions that are up to two-thirds smaller than the traditional cut.

Repair Versus Replacement

Although the Heart and Vascular Center offers cutting-edge procedures for the full spectrum of mechanical and biological valve replacement, our surgeons 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. The Heart and Vascular Center is currently participating in a national clinical trial evaluating the efficacy of valve-sparing procedures in patients with Marfan Syndrome.

Transcatheter Aortic Valve Replacement

If conventional valve repair or replacement is not an option for a patient, a procedure called TAVR (Transcatheter Aortic Valve Replacement ) was approved by federal regulators last November and is now available at Montefiore. During TAVR, a bioprosthetic valve is threaded through the femoral artery via a catheter and then into the heart. Once in position, balloon valvuloplasty is performed to deploy the replacement valve and its frame within the diseased native aortic valve. The procedure is performed in a hybrid catheterization lab and, once perfected, often takes less than an hour. Montefiore Medical Center is among the first wave of sites selected nationwide to launch a TAVR program in 2012. Patients are actively being evaluated for inclusion in Montefiore’s TAVR program. For additional information about the program, visit www.montefiore.org/tavr or call 718-920-7000.

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, obestetrics, gynecology and urology procedures, in which there is a risk of bacterial release into the bloodstream.

Patients with existing valve conditions should talk to their doctors about taking antibiotics before undergoing these routine procedures. For example, a doctor may prescribe an oral antibiotic to be taken by a patient prior to dental work.