Aortic valve replacement is a kind of open heart surgery to treat the aortic valve which is ill.
The aortic valve controls the blood supply of the heart's left ventricle to the body’s main artery known as the aorta. From here, the blood travels to the rest of the body.
It first opens to let the blood flow to all parts of the body and closes to prevent the blood leaking back into the heart.
Instances in which aortic valve is replaced:
Aortic regurgitation: Leakage occurs from the aortic valve into the left ventricle and blood flows back.
Aortic stenosis: Narrowing or thinning of the artery which causes disruption in the blood flow to the Heart.
Aortic valve diseases can be congenital or which arise immediately after birth or due to age related factors or any other factors like obesity, morbidity, smoking or alchohol abuse.
Marfan syndrome: A genetic condition that damages the connective tissues.
Ehlers danlos syndrome: it is a group of inherited conditions that affect collagen proteins in the body, leading to heart valve problems in the long run.
Giant cell arteries: a condition that cause inflammation of the lining of the body’s parts. Endocarditis: a rare but serious condition where the inner lining of the heart becomes inflamed for which there are no reasons.
How is aortic valve replacement carried out?
Actually procedure of the surgery is a bit complicated. An Aortic Valve Replacement is carried out under general anaesthesia, means you will be asleep during the operation and not feel any pain. The surgeon will begin the operation by making a large cut down the centre of your breastbone (sternum). This will be around 25cm (10 inches) long. This is known as a sternotomy and it allows the surgeon to access your heart. The heart is then stopped and a heart-lung bypass machine is used to take over the circulation during the operation. Then the aortic valve is removed and replaced with an artificial valve (prosthesis). The heart is then started again and the chest incision is closed.
Heart-lung machine
Tubes are inserted into the heart and major blood vessels, which are attached to a heart-lung (bypass) machine. When this is turned on, blood is diverted into the machine instead of your heart. The machine pumps oxygen-rich blood around the body until the operation is complete, taking over the role of your heart and lungs.
Your heart is stopped by filling the coronary arteries (the blood vessels that supply your heart with blood) with a chemical solution. The body’s main artery (aorta) is shut, so that the surgeon can open the heart and operate without blood pumping through it.
Replacing the aortic valve
The surgeon will open up the aorta, so that they can see the aortic valve. The damaged valve is removed, and the new one put into place and attached with a fine thread (suture).
The surgeon will start the heart again, using controlled electric shocks, before taking you off the bypass machine. The breastbone will be joined up with wires, and the wound on the chest closed using dissolvable stitches. Tubes are inserted into small holes in your chest (called chest drains) to drain away any blood and fluid that builds up.
The operation may be performed using smaller incisions and instruments, but you will still need to be connected to the bypass machine.
Types of valves:
There are two main types of replacement valve :
Mechanical valves, which are made of man-made materials such as pyrolytic carbon (similar to graphite). Mechanical valves are very hard and long lasting.
Biological valves, which are made of animal tissue. There is less risk of blood clotting. Therefore anticoagulant medication is not usually needed.
Each type of valve has advantages and disadvantages. Generally, if under 60 years of age, the surgeon will recommend a mechanical valve replacement. If over 65, a biological valve replacement is usually recommended.
The surgery lasts for about two to three hours and post operative care in intensive care unit is about 10 to 12 hours and hospitalization period is about two days to seven days depending on the prognosis of the patient.
Uusally the replacement is recommended after diagnostic tests such as ECG, 2D echo, 3D echo or other associated test results.
Possible complications though minimal, may include
- Irregular heartbeat or arrhythmia
- Ischemic Attack or cut in blood supply to the brain
- Kidney failure
- Infection to the new valve or underlying areas.
There are replacement options available such as
- Transcathter aortic valve implantation
- Aortic valve balloon valvuloplasty
- Suture less aortic valve replacement
At KIMS we have specialised equipment and Team of well versed Doctors who perform this procedure with utmost care and concern.