Aortic valve surgery
The aortic valve can sometimes be repaired, but the majority of patients who require surgery currently benefit most from aortic valve replacement.
There are a number of choices available:
Mechanical valve replacement
The benefit of mechanical valve replacement lies in the fact that modern valves demonstrate little or no evidence of structural deterioration. Their only caveat is that they can promote clot formation on their surface. For this reason, patients require life long anticoagulation with Warfarin, a daily tablet, which inhibits the clotting mechanism. A patient on Warfarin requires regular blood tests in order to ensure that the degree of anticoagulation is optimal. Excessive anticoagulation can produce dangerous bleeding complications that are more common in older patients.
Bioprosthetic (tissue) valve replacement
A bioprosthetic valve can be made from pigs’ valves or from the pericardium of a cow. There is no risk of cross infection and Warfarin is not a requirement. Unfortunately, bioprostheses can wear away so that whilst patients’ over the age of 70 years old can expect a durability of 75 to 80% at 10 years postoperatively, younger, more active patients will usually require revision surgery much sooner.
Newer bioprosthetic valves, known as “Sutureless Valves” are now available. They offer a significant advantage in terms of the speed with which they can be deployed, and are a revolution for high risk patients who require a quick operation to improve recovery, as well as for patients undergoing keyhole aortic valve replacement.
Percutaneous aortic valve implantation (TAVI)
This procedure entails the insertion of a new bioprosthetic aortic valve percutaneously through the groin, a small incision over the left chest, or via a small breastbone incision. The procedure is reserved for specific patients who are unsuitable for traditional surgery. This is because TAVI is associated with a higher risk of stroke, as well as concerns regarding leakage around the edges of the new valve.
Keyhole Aortic Valve Surgery
Keyhole aortic valve surgery can be performed via a small breastbone incision or through a small incision between the ribs on the right side of the chest. The recovery from these approaches are very compelling when performed by experienced teams.