Surgical Aortic Valve Replacement (SAVR)

It is a condition in which the aortic valve becomes obstructed. These stiff, fused, thickened, inflexible valve leaflets cause the aortic valve to constrict, limiting blood flow. Aortic valve stenosis progresses when calcium is deposited on the valve leaflets, further limiting their mobility. Stenosis can develop in people who have a tricuspid (3 leaflet) or bicuspid (2 leaflet) aortic valve.

These valve leaflets do not entirely close. Regurgitation happens when the blood ejected by the heart returns to the heart as soon as it stops squeezing and relaxes. Regurgitation can be caused by floppy leaflets (prolapse), aberrant congenitally malformed valves (bicuspid or unicuspid), valve infection (endocarditis), the inability of the leaflets to shut securely owing to aortic dilatation (aneurysm), holes in the leaflets, or rheumatic valve disease.

Infective endocarditis is a bacterial infection of the valve that occurs when germs enter your bloodstream from a distant illness and adhere to the surface of your heart valves. Even small infections, such as a dental abscess, can result in serious bacterial endocarditis of the aortic valve.

Rheumatic fever is typically caused by a bacterial throat infection, such as strep throat. In rheumatic fever, the valve itself is not diseased, but antibodies produced by the body to combat infection react with the heart valves, causing stiffness and fusing of the aortic valve leaflets.

Aortic valve degeneration from wear and tear is another cause of acquired aortic valve disease. The aortic valve leaflets deteriorate and become calcified in many individuals over time. This most commonly results in aortic stenosis, although it can also result in aortic regurgitation. In adults over the age of 65, this is the most prevalent cause of aortic stenosis.

Other causes of aortic valve illness include rheumatoid arthritis, chronic inflammatory disorders, lupus, syphilis, hypertension, aortic aneurysms, connective tissue diseases, and, less frequently, tumours, certain types of medications, and radiation for malignancies or lymphoma.

Aortic valve surgery is classified into two types: aortic valve repair and aortic valve replacement.

The aortic valve may be repaired or replaced through aortic valve surgery, which also includes aorta surgery. The findings of your diagnostic tests, the anatomy of your heart, your age, the existence of other medical disorders, and other considerations will be taken into account to determine whether aortic valve repair or replacement is the best treatment option for you.

Traditional heart valve surgery or less invasive methods can be used to conduct aortic valve surgery.

A surgeon creates a 6- to 8-inch incision through the middle of your sternum during conventional aortic valve surgery, and part or all of the sternum (breastbone) is split to allow direct access to your heart. Your abnormal heart valve or valves are then repaired or replaced by the surgeon.

Minimally invasive aortic valve surgery is a type of aortic valve repair surgery performed through smaller, 2- to 4-inch incisions without opening your whole chest. This is generally accomplished through a "J" incision and leaves your chest stable. Minimally invasive surgery minimises blood loss, trauma, hospital stay time, and often may hasten healing.

Most patients who require isolated aortic valve surgery are candidates for minimally invasive aortic valve surgery, but your surgeon will review your diagnostic tests and determine if you are a candidate for this type of surgery.

Aortic valve dysfunction is frequently linked with an expansion (aneurysm) of the ascending aorta, the aorta's first section (the main blood vessel in the body that originates from the aortic valve).

If the aorta expansion is significant (typically greater than 4.5 or 5 cm in diameter), this section of the aorta may need to be replaced. The replacement is performed at the same time as the aortic valve repair or replacement. A specific operation (David procedure) can be done on individuals who have a leaking aortic valve and an enlarged aorta. Using the David technique, surgeons can repair the aortic valve while also replacing the enlarged ascending aorta.

The majority of aortic valves are replaced with a bioprosthesis at Our Hospital. Biological valves (also known as tissue or bioprosthetic valves) are composed of tissue, although they may contain some artificial components to give additional support and allow the valve to be stitched in place.

About 80% of aortic valves are replaced with bioprosthesis

Biological valves can be produced from porcine tissue, bovine pericardial tissue, or other species' pericardial tissue.

These valves are easy to install, long-lasting (lasting 15 to 20 years), and allow patients to avoid taking anticoagulants for the rest of their lives (blood-thinning medications). At Our Hospital, the risk of death following isolated aortic valve replacement is less than 1% and has continuously been lower than expected mortality based on Society of Thoracic Surgeons (STS) national data.

Mechanical valves are entirely composed of mechanical elements that are non-reactive and easily tolerated by the body. The bileaflet valve is used most often.

It is made up of two pyrolite (diamond-like) carbon leaflets in a ring wrapped in polyester knit fabric.

All patients with mechanical valve prostheses need to take an anticoagulant medication (blood thinning medication), warfarin (Coumadin), for the rest of their life to ensure the valve works smoothly and reduces the risk of blood clotting and stroke. Blood thinning also reduces the risk.

The Ross procedure is often performed on patients under the age of 30 who want to avoid the need for anticoagulants (blood-thinning medicines) for the rest of their lives.

During this procedure, the patient's normal pulmonary valve is removed and used to replace the diseased aortic valve. The pulmonary valve is then replaced with a pulmonary homograft. The Ross procedure leaves two valves at potential risk of later failure.