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Aortic Valve Replacement:
A guide to the procedure, risks, and recovery

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1.What is Aortic Valve Replacement?

Aortic Valve Replacement surgery

The key function of the Aortic valve is to pump the blood and keep it flowing to the rest of the body, in the right direction. The aortic valve functions as a separation between the heart’s left ventricle and the aorta, and it supplies oxygenated blood throughout the body. Each contraction of the heart opens up the aortic valve, allowing blood to flow through, and once it relaxes, the aortic valve closes and prevents any blood from seeping back into the ventricle. Any kind of malfunction in the valve mechanism can cause the heart to expend more effort in pumping the blood to the entire body. This can cause strain on the heart, especially if it persists for a prolonged period.

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2.Why is Aortic Valve Replacement performed??

An Aortic valve repair, or replacement, is performed if the patient suffers from an Aortic valve disease that hampers the functioning of the valve, and impairs blood flow from the heart to the rest of the body. The diagnosis and treatment depends on the kind of condition and the level of impairment to the valve function.

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3.Conditions that require Aortic Valve Replacement

Congenital Heart Disease:

In certain cases, congenital heart defects (Defects from birth) may lead to a condition called aortic valve regurgitation. This is where the valve doesn’t function properly and the blood flows back into the ventricle. There may be conditions, such as the valve being too small or too large or even the wrong shape, that affects the blood flow through it, and this is called atresia. In minor cases that don’t exhibit symptoms, it can be treated with supervision; however, since aortic valve disease often progressively gets worse with time, it may require surgical intervention. Without timely intervention, there is a high risk of complications such as heart attack, sudden cardiac arrest, or heart failure.

Aortic Valve Regurgitation:

If the aortic valve functioning is impaired the blood that is supposed to flow from the ventricle to the aorta may seep back into the ventricle. This could be attributed to a dysfunctional valve that is leaky. This could be the case in the case of a misshapen valve (Congenital Defect) or in the case of a bacterial infection that weakens the valve.

Aortic Valve Stenosis:

Stenosis is when it is harder for the heart to pump blood because the aortic valve is too narrow or obstructed. It may occur due to congenital heart disease, rheumatic heart disease, or the thickening of the aortic valves flaps, which can cause it to malfunction.

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4.Types of Aortic Valve Replacement

Mechanical Valve Replacement:

A mechanical man-made valve that is made up of strong durable materials is used to replace the natural valve. Mechanical heart valves are usually designed as bi-leaflet, that means that the valve has two leaflets that act as a ‘unidirectional mechanism’ that ensures the blood flow the right way, from the ventricle to the aorta without any chance for backflow.

Ross Procedure:

It is usually carried out in younger patients. In this procedure, a patient’s pulmonary valve is used to replace the damaged aortic valve, and this is called autograft. Later the autograft is replaced by a pulmonary valve from a human donor, and this is called a homograft. The advantage of the procedure is that valves are replaced in such a way that they are shown to grow with the body, if implanted during childhood.

Tissue Valve (Either animal or human donors)/ Bioprosthetic Aortic Valve Replacement:

Tissue valves may be harvested from a cow in which case it’s called a Bovine Aortic Valve Replacement, or from the heart of a pig in which case it’s called Porcine Aortic Valve Replacement. These tissues undergo a medical procedure to make sure that the body does not reject them. The advantage of this procedure is that it reduces the need for blood thinners to be used in the long term. The only disadvantage of tissue valves is their tendency to wear out, and they require replacement in five years or so.

TAVI/TAVR procedure (Transcatheter Aortic Valve Replacement):

Also called Transcatheter aortic valve implantation, it is a procedure in which aortic valve stenosis is treated in a minimally invasive manner. In this procedure, a catheter is inserted through the femoral artery up to the aortic valve. They may also access the valve through an incision in the chest wall and through the apex of the heart. A replacement valve is deployed in the place of the old one to restore the blood flow and function.

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5.Are you the right candidate for this procedure?

The kind of procedure Aortic Valve repair or Aortic Valve Replacement depends largely on the severity of the symptoms you experience. Your age, overall health, other heart conditions or complications all fact into the course of treatment that is chosen.

Heart valve repair is usually preferred if the condition is not too severe as there is a lower risk of the body rejecting the treatment and a reduced risk of infection. It also reduces the need for blood-thinning medications that are needed after a heart valve replacement. The doctor will conduct a thorough diagnosis of your heart condition and function before suggesting either treatment.

These procedures can either be conducted through open-heart surgery or through minimally invasive methods. Minimally invasive methods are generally preferred as there is a lower risk of complications, less scarring, less pain, and a faster recovery than in the case of a traditional procedure.

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6.How do I prepare for the procedure?

Your medical team will take special care to inform you of all the risks and complications that are associated with the surgery. You must ask the team of any questions or concerns you may have with the procedure,

Here are some of the questions you must ask your doctor before the procedure:

  • Will your medication regimen need to be altered or changed before or after the procedure?
  • What are the dietary recommendations before or after the procedure?
  • What kind of physical activity is restricted before or after the procedure?
  • How long will you take to recover completely?
  • What will be the expenses for the procedure and the hospital stay?

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7.Complications and risks that may arise

Risks of Aortic Valve Replacement

The risks of the procedure greatly depend on your bill of health, before the procedure is conducted, as well as, the experience and expertise of your medical team. Hence, you need to do an adequate amount of research on the team that is involved in conducting your surgery, and the infrastructure available at the medical centre. It also helps to enquire about the number of similar procedures that the team has conducted as well as the success rate of the procedure at the centre.

Some of the risks associated with the procedure include:

  • Clotting of blood
  • Excessive bleeding
  • Dysfunction of replaced valves
  • Arrhythmia (Problems with the rhythm of the heart)
  • Stroke
  • Infections
  • Death

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8.Understanding the procedure:

Aortic Valve Replacement

This procedure entails the doctor surgically removing your malfunctioning heart valve and replacing it with a functional valve, this can either be mechanical, bioprosthetic from animals (Cows or Pigs) or humans. It’s also possible that your own pulmonary valve tissue is used in a procedure called autograft also known as the Ross procedure.

In the case of biological tissue being used, the valve may wear out over time and need to be replaced. However, if you choose to go for a mechanical valve, you will have to use blood-thinning medications throughout life as a way to prevent the likelihood of blood clotting.

The doctor will explain all the pros and cons as well as the best recourse for your particular condition while choosing a treatment. It’s important you consider your lifestyle, your adherence to medication regimens, your age and your level of activity when making a decision as to which procedure to opt for. Your medical team will explain the most suitable procedure for you and will explain the options available.

Aortic Valve Repair

In Aortic valve repair, the medical team usually performs open-heart surgery and inserts tissue to patch any kinds of malformations in the aortic valve. It may also involve adding tissues to the base of the valve to ensure that the blood does not flow back into the ventricle. Other repairs also included separating fused valve flaps, as well as, tightening of the muscles around the valve.

In the case of children suffering from aortic valve stenosis, repairs are usually done with a less invasive procedures such as balloon valvuloplasty in which a catheter is inserted into the heart and the valve is opened up and then a mechanical valve or tissue valve is used to replace the faulty aortic valve. However, in such a procedure there is a chance of the valve narrowing down again which may need other treatment procedures.

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9.Road to recovery

An Aortic valve repair is a complex medical procedure so you’ll have to take certain medications and also attend regular follow up appointments to ensure a full recovery. Depending on the kind of transplant, you may need blood thinners to avoid blood clots being formed. You can eventually get back to your daily physical activity and your work schedule.

The doctor will also recommend changes to your lifestyle such as a heart-healthy diet, quitting smoking, and stress management to avoid any complications that may arise.

Your doctor may also prescribe cardiac rehabilitation to expedite your recovery from the procedure. Cardiac rehab is a medically supervised program that involves counselling and training for heart-healthy exercises, information about lifestyle changes and risks as well as ways to successfully manage stress in your day to day life. Adherence to Cardiac rehab will help you improve your cardiovascular health in the long term and reduce the chances of a heart attack, heart failure or any complications with the aortic valve in the future.

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10.Precautions to take

  • Follow your doctor’s recommendations religiously and adhere to medications prescribed
  • Good nutrition can speed up your recovery, ensure you follow a heart-healthy diet.
  • Meal planning can help you from falling off the wagon.
  • Ensure that you pace yourself in the recovery period, work your way up to your earlier level of activity.
  • Before undertaking any strenuous physical activity make sure you check with your doctor.
  • Include moderate physical activity of at least 150 minutes a week after checking with your physician.

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11.Aortic Valve Replacement FAQs: All your concerns addressed.

Q.   What is Aortic Valve Replacement?

  1. The valves, which responsible for blood flow through the chambers of the heart, sometimes are blocked and can't perform the task well. The aortic valve which is on the left side of the heart is responsible for the blood outflow. If this aortic valve has a congenital defect, it causes stenosis or regurgitation. Surgery helps to replace this valve for better functioning.

Q.  What is the success rate of aortic valve replacement surgery?

  1. Heart valvuloplasty and valve replacement, when performed for elderly patients, the success rate is very high. Though the prognosis could only be improved by optimizing preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment.

Q.   How dangerous is heart valve replacement surgery?

  1. More than 95 per cent of people who undergo coronary bypass surgery do not experience serious complications. The risk of death immediately after the procedure is only 1 or 2 per cent.

Q.   How long does an aortic valve replacement take?

  1. Depending on the number of valves that need to be repaired or replaced, the surgery can take anywhere from 2 to 4 hours or more. The patient is expected to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU).

Q.   Is heart valve replacement a major surgery?

  1. Heart valve replacement surgery and procedures are performed to repair or replace a heart valve that is not working properly because of valvular heart disease. It is a major operation as it is an open-heart surgery through the breastbone, into the chest.

Q.   Can the aortic valve be replaced without open-heart surgery?

  1. Open-heart surgery was the only option for replacing the valve, until recently. But a treatment called Transcatheter Aortic Valve Replacement, or TAVR, offers a less invasive alternative with an easier, shorter recovery.

Q.   Which heart valve is the most difficult to replace?

  1. There are 4 valves in the human heart - Aortic valve, Mitral valve, Tricuspid valve, and Pulmonic valve. The aortic valve replacement is the most common procedure and is not dangerous. The mitral valve is mostly repaired when needed. Only the tricuspid valve or the pulmonic valve is rarely repaired or replaced.

Q.   Does the rib cage need to be opened up for open-heart surgery?

  1. In open-heart surgeries, the surgeon will make a 6- to 8-inch incision (cut) right in the middle of your chest wall. The surgeon will cut the breastbone and open the rib cage to reach your heart. All major precautions are taken in the process. The patient will be given medication to thin out the blood and to keep it from clotting. A breathing tube, connected to the ventilator, will be placed in the lungs through the throat.

Q.   What is the average age for heart valve replacement?

  1. Average patient age for a heart valve replacement is 53 to 92 years.

Q.   What is the most common kind of heart valve replacement?

  1. Aortic valve replacement is the most common valve surgical procedure for aortic stenosis, or narrowing of the aortic valve. Aortic regurgitation is another common valve problem that requires valve replacement. Regurgitation is a condition where the valve allows blood to return back into the heart instead of flowing it out. This condition might cause heart failure. Mitral stenosis is another condition that sometimes requires a valve replacement procedure.

Q.   What is the life expectancy after undergoing a procedure that involves an Aortic Valve Replacement?

  1. The life expectancy depends entirely on the severity of the disease before the procedure. It also depends on a variety of factors such as age, bill of health, sex, ethnicity and lifestyle. In a study conducted in the UK of the long term outcomes after Aortic Valve Replacement survival rates ranged from 16 years for people aged < 65 years old and 6-7 years for those aged > 75. However, the process may need for monitoring through regular intervals as bioprosthetic valves are likely to wear out and need replacement.

Q.   How dangerous is Aortic Valve Replacement?

  1. The safety of the procedure will depend on the expertise of your medical team with the procedure. However, complications could include excessive bleeding, stroke, heart attack and rejection of the valve by the body.

Q.  Can Aortic valve be replaced without open-heart surgery?

  1. Earlier Aortic valves were usually replaced using open heart procedures, however, innovative procedures such as TAVR (transcatheter Aortic Valve Replacement) can be done via a small incision.

Q.  What are the symptoms of aortic valve problems?

  1. In some cases, aortic valve issues may not show any external symptoms, however, in case they do exhibit it may include:

Q.  What is the most common complication of Aortic Valve Replacement?

  1. Heart attack, stroke or chest wound infection has been reported in the case of open-heart surgery.

Q.  What are the changes I should make to my diet?

  1. After Aortic Valve Replacement, your physician will advise you to strictly avoid all foods that are high in sugar and sodium. This includes processed foods and baked goods that might contain artificial preservatives.

Q.  What is the best kind of valve replacement?

  1. There are two kinds of valve replacements Mechanical and Biological/Bioprosthetic which can either be from human or animal donors. Each has its own set of pros and cons, your doctor will help you decide which is the best one for you.

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