What is Aortic Valve Replacement?
Aortic Valve Replacement (AVR) is a surgical procedure performed to address issues with the aortic valve, a critical component of the heart that helps regulate blood flow from the heart’s left ventricle into the aorta and onwards to the rest of the body. This procedure is necessary when the aortic valve becomes narrowed (stenosis) or leaky (regurgitation), impairing the heart’s ability to function effectively.
AVR is typically recommended when the aortic valve’s functionality is compromised to the extent that it affects overall heart function and health. Indications for AVR include:
- Severe Aortic Stenosis: The aortic valve becomes stiff and narrow, restricting blood flow.
- Severe Aortic Regurgitation: The aortic valve does not close properly, allowing blood to flow back into the heart.
- Symptomatic Heart Disease: Symptoms like chest pain, shortness of breath, or fainting that result from valve dysfunction.
- Heart Failure: Progressive heart failure due to valve disease.
Symptoms Indicating the Need for Aortic Valve Replacement
Symptoms related to aortic valve dysfunction can vary based on the severity of the condition. Common symptoms include:
- Shortness of Breath: Difficulty breathing, especially during physical activity or when lying down.
- Chest Pain or Discomfort: Pain or pressure in the chest that may radiate to the shoulders, neck, or arms.
- Fainting or Dizziness: Sudden loss of consciousness or feeling lightheaded, often due to reduced blood flow to the brain.
- Fatigue: Unusual or extreme tiredness, even with minimal exertion.
- Swelling: Fluid buildup in the legs, ankles, or abdomen due to heart failure.
- Palpitations: Irregular or rapid heartbeats that may be felt as a fluttering sensation in the chest.
Types of Aortic Valve Replacement
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There are two primary types of aortic valves used in replacement:
- Mechanical Valves: Made from durable materials designed to last a lifetime. They require lifelong monitoring and regular follow-ups.
- Biological Valves: Made from animal tissues (such as pig or cow valves) or human cadaver tissue. They generally have a shorter lifespan compared to mechanical valves but often do not require long-term medication.
Preoperative Assessment
Before the AVR procedure, a comprehensive evaluation is conducted, including:
- Medical History Review: Discussion of symptoms, previous heart conditions, and overall health.
- Physical Examination: Assessment of heart sounds and overall cardiovascular health.
- Imaging Tests: Echocardiogram, chest X-ray, and sometimes a CT scan to visualize the aortic valve and assess the extent of the valve dysfunction.
- Blood Tests: To evaluate overall health and identify any issues that might affect surgery.
Surgical Procedure
The AVR procedure involves several key steps:
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free during the procedure.
- Incision: A cut is made down the middle of the chest to access the heart. In some cases, less invasive techniques might be used.
- Cardiopulmonary Bypass: A machine takes over the function of the heart and lungs to allow the surgeon to operate on a still heart.
- Valve Removal: The damaged aortic valve is carefully removed.
- Valve Implantation: The new valve is positioned and securely attached.
- Closure: The incision is closed with sutures, and the patient is gradually brought out of anesthesia.
Postoperative Care
After the procedure, the following steps are typically undertaken:
- Recovery Room: The patient is monitored closely in a recovery area for vital signs and overall stability.
- Hospital Stay: The typical hospital stay ranges from 5 to 10 days, depending on the patient’s recovery progress.
- Pain Management: Pain is managed through appropriate means, with attention to any post-surgical discomfort.
- Rehabilitation: Gradual physical activity is encouraged to help the patient regain strength and improve cardiovascular health.
- Follow-Up Appointments: Regular check-ups with a cardiologist to monitor the function of the new valve and overall heart health.
Potential Risks & Complications
As with any major surgery, AVR carries some risks, including:
- Infection: Risk of infection at the incision site or in the heart.
- Bleeding: Excessive bleeding or blood clots.
- Valve Dysfunction: Potential issues with the new valve.
- Heart Rhythm Problems: Irregular heartbeats or arrhythmias.
- Kidney Problems: Temporary or permanent kidney issues.
Aortic Valve Replacement & Aortic Valve Repair
Aortic valve repair and aortic valve replacement are procedures that treat diseases affecting the aortic valve. Types of Aortic Valve Surgery are:
- An annuloplasty is a procedure to tighten or reinforce the ring around a valve in the heart.
- A valvuloplasty, also known as balloon valvuloplasty or balloon valvotomy, is a procedure to repair a heart valve that has a narrowed opening.
Open Heart surgery versus Catheter method of Heart Replacement
Traditionally, all valve replacement procedures required a open-heart surgery. However, recent advances in catheter methods have resulted in the development of catheter- based (non-surgical) heart valve replacement procedures.
The Catheter based approach to Valve Repair is generally recommended in case of Valve Stenosis (condition in which the valve narrows down).The procedure is called Transaortic Valve Implantation/ Replacement (TAVI/TAVR) for Aortic Valve Repair. In case of Mitral Valve Repair, it is called Transaortic Mirtral Valve Implantation/ Replacement (TMVI/R).
TAVI / TMVI is the first line of treatment in cases of Valve narrowing /stenosis.
The advantage of TAVI/TMVR is that in this procedure, the valve is replaced with no scar (unlike surgery) and recovery time is minimal.
However, in cases of Valve Regurgiation (leakage), surgery is still required / recommended.
Lifestyle Adjustments and Long-Term Management
Post-surgery, patients are advised to:
- Adopt a Heart-Healthy Diet: Low in saturated fats, cholesterol, and sodium.
- Engage in Regular Exercise: As recommended by healthcare providers to improve cardiovascular health.
- Avoid Smoking and Limit Alcohol: Both can negatively affect heart health.
- Adhere to Follow-Up Care: Regular visits with healthcare providers to monitor valve function and heart health.