Can My Aortic Valve Be Saved? The Truth About Bicuspid Valves and Aneurysm Surgery
Bicuspid Aortic Valve and Valve-Sparing Aortic Root Surgery (David Procedure)
Facing a new diagnosis of bicuspid aortic valve or aortic root aneurysm can feel overwhelming. This brochure demystifies these conditions and highlights modern, patient-friendly treatment options. You’ll learn what BAV and aortic root disease are in simple terms, why not all bicuspid valves require replacement, and how innovative surgeries like the David procedure (a valve-sparing aortic root replacement) can preserve your own valve. We’ll also explain the benefits of “keyhole” minimally invasive surgery versus traditional open-heart surgery, introduce the Keyhole Heart Clinic as a world-class center, and share real patient stories. Our goal is to empower you with knowledge so you can make informed decisions – including seeking a second opinion – and move forward with hope and confidence.
What is a Bicuspid Aortic Valve (BAV)?
The aortic valve is the heart’s outflow valve that prevents blood from leaking back into the heart. In most people it has three flexible “leaflets” (tricuspid), but about 1% of people are born with a bicuspid aortic valve, meaning it has only two leaflets. This is a common congenital variation. Often, a bicuspid valve works normally for years without causing any symptoms or problems. However, because of its altered structure, a BAV can be prone to issues over time.
How Can a Bicuspid Valve Affect the Heart?
Having a bicuspid aortic valve increases the risk of certain heart problems as you age. Over the years, a BAV may undergo wear-and-tear changes: the valve can become stiff or calcified, leading to aortic stenosis (narrowing of the valve). In fact, many patients who develop aortic valve stenosis in middle age are found to have a bicuspid valve. Severe aortic stenosis causes the valve to not open fully, restricting blood flow; if it becomes critical, the valve must be treated or replaced to prevent serious outcomes.
In other cases, a bicuspid valve may not close tightly, causing aortic regurgitation (a leaky valve) where blood flows backward into the heart. This leak can lead to symptoms of heart failure (fatigue, shortness of breath, etc.) if untreated. The good news is that some leaky bicuspid valves can be repaired instead of replaced, depending on the valve’s condition. In fact, in many patients with BAV, it’s often the associated issues (like the aorta enlarging) that need fixing, while bicuspid aortic valve repair can be done to save the patient’s own valve. Your cardiac surgeon will assess whether your BAV is suitable for repair or if replacement is necessary based on its structure and function.
Bicuspid Aortic Valve Disease and Aortic Root Aneurysm
One critical aspect of bicuspid aortic valve disease is its link to the aorta, the main blood vessel carrying blood from the heart. Many people with BAV have an inherited weakness in the wall of the aorta, especially the ascending aorta or aortic root (the section of the aorta attached to the heart). Over time, this weakness can cause the aorta to stretch and bulge out, forming an aneurysm. An enlarged aortic root or aneurysm is serious: if it grows too large it can tear (aortic dissection) or even rupture, which is life-threatening.
For BAV patients, doctors closely monitor the aorta’s size. If the aortic root reaches a certain diameter (often around 4.5–5.0 cm, or smaller if it’s growing quickly), proactive surgery to replace the enlarged aorta is usually recommended to prevent a rupture. This condition – sometimes called aortic root disease – often requires surgery even if the valve is working fine, simply because of the aneurysm risk. In many BAV cases, both the valve and the aorta may need attention: either the valve is diseased and the aorta is enlarged, or the valve is okay but the root is aneurysmal. Traditionally, such patients might undergo a composite valve-and-root replacement (replacing the aorta and inserting an artificial valve at the same time). However, there is a modern alternative that can treat the aneurysm while preserving your own valve when the valve is healthy enough – this is where the David procedure comes in.
What is the David Procedure (Valve-Sparing Aortic Root Surgery)?
The David procedure – formally known as aortic valve-sparing aortic root replacement – is an advanced surgical technique to treat an enlarged aortic root (aneurysm) without replacing the patient’s own aortic valve. In a standard aortic root replacement (such as the Bentall procedure), surgeons remove the patient’s aortic valve and replace it with a mechanical or biological valve attached to an artificial graft for the aorta. By contrast, in the David procedure the surgeon preserves your native valve: the diseased section of the aorta (the aortic root) is cut out, but the patient’s own valve leaflets are kept. The surgeon then implants those valve leaflets into a new synthetic aortic root graft (tube) and reattaches the coronary arteries, effectively rebuilding the aortic root around your original valve. In simple terms, it’s like repairing the “foundation” (the aortic root) and placing your original valve inside the new foundation so it can continue to function.
This procedure is named after Dr. Tirone David, the surgeon who pioneered it. It is a complex operation usually done in specialist centres. Mr. Inder Birdi and the Keyhole Heart Clinic team regularly perform the David procedure for suitable patients – in fact, Mr. Birdi is one of the few surgeons in the UK with the expertise to perform this valve-sparing aortic root replacement. The goal of the surgery is to cure the aneurysm (by replacing the enlarged aorta) while keeping the patient’s own bicuspid aortic valve (if the valve is structurally healthy or can be repaired). This is particularly beneficial for patients whose valves are leaking (regurgitation) but not heavily calcified – often the case in BAV patients with aneurysms.
Benefits of Valve-Sparing Root Replacement vs. Traditional Replacement
Opting to repair and preserve your bicuspid valve instead of replacing it can have several advantages:
- No Artificial Valve Needed: By preserving your valve, you avoid having a mechanical or animal tissue valve implanted. Artificial valves can work well but come with trade-offs (like noise or limited lifespan).
- No Lifelong Blood Thinners: Mechanical valve replacements require lifelong anticoagulation (blood thinner medication) to prevent clots. A repaired natural valve spares you this requirement – meaning less medication and no associated bleeding risks from anticoagulants.
- Better Heart Function: Your natural valve (especially if it’s been expertly repaired) typically provides superior hemodynamics – in other words, blood flows more naturally and efficiently compared to flow through an artificial valve. This often translates to better long-term heart performance and may help the heart recover closer to normal function after surgery.
- Durability: Studies have shown that a well-repaired aortic valve can be very durable. Many patients’ repaired valves function well for decades, sometimes outlasting bioprosthetic (tissue) valves. In younger patients, keeping your own valve means you’re less likely to need another valve replacement surgery in the future.
Of course, not every valve can be saved. If a bicuspid valve is heavily calcified or malformed, replacement might be the safer option. But an expert surgeon will carefully evaluate if valve-sparing root surgery is feasible in your case. Mr. Birdi emphasises that every patient with severe aortic regurgitation or aneurysm is considered for valve repair at their multidisciplinary team meeting. This ensures that, whenever possible, you get to keep your own valve.
Minimally Invasive “Keyhole” Heart Surgery – Reducing Trauma
Facing heart surgery can be daunting, especially the prospect of a large incision down the chest. At The Keyhole Heart Clinic, the team has extensive expertise in minimally invasive heart surgery (also known as “keyhole” heart surgery), which uses smaller incisions to perform the same operations with less trauma. In suitable patients, bicuspid aortic valve repair or replacement and aortic root surgery can be performed through keyhole approaches, avoiding the need to fully split the breastbone. For example, surgeons may use a mini-sternotomy (a partial split of the breastbone only at the top) or a small incision between the ribs on the right side of the chest to access the aortic valve and root. These minimally invasive routes provide the same life-saving repair but with a much smaller wound.
What are the benefits of keyhole heart surgery?
Patients who meet the criteria for a minimally invasive approach often experience: less pain, less bleeding, lower infection risk, faster healing, and a smaller scar. Unlike the conventional full sternotomy (which takes about 12 weeks to heal and leaves a long scar), a keyhole incision can heal in a matter of days to a few weeks, with far less impact on bone and tissue. There are also cosmetic advantages – the incision is much smaller and can often be hidden in a skin crease. Most importantly, keyhole surgery has been shown to be as safe and effective as traditional open surgery when performed by experienced teams. Mr. Birdi’s team has been a pioneer in these techniques, and The Keyhole Heart Clinic is internationally recognised as a leader in minimally invasive cardiac surgery, performing among the highest number of keyhole procedures in the UK over the last 20+ years. For patients, this means you can have state-of-the-art surgery with the confidence of a faster recovery and excellent outcomes.
Real Patient Story: Life-Changing Valve-Sparing Surgery
To truly understand the impact of the David procedure and keyhole surgery, it helps to hear from someone who’s been through it. One recent patient story stands out: a gentleman with a bicuspid valve had developed a large aortic aneurysm – essentially “a ticking time bomb,” as his wife described it. They sought out Mr. Inder Birdi for help. “To cut a long story short, I somehow found our saviour, Mr Birdi!” his wife wrote. “He performed an eight-hour operation without causing major trauma to the chest [via a keyhole approach]. He also saved the healthy aortic valve, when other consultants had suggested replacing it. If you need a heart surgeon this is your guy!! … We simply cannot thank him enough.”.
This family’s experience highlights a few key things: First, how crucial a second opinion can be – they were originally advised elsewhere that the valve had to be replaced, but Mr. Birdi was able to repair and spare the valve. Second, it shows the benefit of a skilled minimally invasive approach (even a complex 8-hour surgery was done with much less trauma than a standard operation). And finally, it underscores the level of dedication and care at The Keyhole Heart Clinic, where patients feel truly looked after during a very stressful time. Real-world testimonials like this, along with over 100 independent five-star patient reviews, give confidence that you’re in the best of hands.
Getting a Second Opinion – Exploring All Options
If you or a loved one has been told you need major heart surgery – for example, an aortic valve replacement and root replacement – it’s natural to feel anxious and to wonder if there are alternative approaches. Seeking a second opinion can be incredibly valuable, especially with a specialist in valve-sparing and minimally invasive techniques. At The Keyhole Heart Clinic, Mr. Birdi and his team offer a comprehensive second opinion service to help patients make informed decisions. Often, they can confirm a diagnosis and discuss less invasive or valve-preserving treatments that might not have been offered elsewhere.
There is no obligation to undergo surgery at our clinic – the goal is to empower you with expert insight so you can confidently choose the best path forward for your health.
Patients who have used our second opinion service often express relief and gratitude afterward. As one patient noted, “Following a recommendation I sought a second opinion from Mr Birdi. The level of expertise, service and care from Mr Birdi and his support staff was exemplary, and in a very short time my condition was thoroughly investigated and a treatment plan formulated. I cannot recommend him more highly.”. This underscores how a fresh evaluation by a world-renowned specialist can bring peace of mind. Whether it’s confirming that surgery is truly needed, finding out if a valve-sparing root replacement (David procedure) is possible, or learning that a minimally invasive heart surgery approach could be used in your case, a second opinion with our team can provide clarity. We encourage patients, especially those diagnosed with bicuspid aortic valve disease or aortic aneurysms, to take advantage of this service – even if you’re located outside the UK, virtual consultations can often be arranged.
World-Class Expertise at The Keyhole Heart Clinic
Choosing the right surgeon and centre for your heart surgery is perhaps the most important decision you’ll make in this journey. The Keyhole Heart Clinic, led by heart surgeon Mr. Inderpaul (Inder) Birdi, offers a unique depth of experience in exactly the areas BAV and aneurysm patients need. Mr. Birdi is an internationally recognised cardiac surgeon with over 20 years of experience, known for his expertise in minimally invasive heart surgery. He has performed thousands of heart operations, including complex valve repairs and replacements through small incisions, and is a pioneer in minimally invasive aortic surgery and keyhole techniques in the UK. Notably, he is one of the few surgeons in the UK who routinely performs the David procedure (aortic valve-sparing root replacement) – meaning that patients here have access to valve-preserving surgery that might not be available at other centers. Under Mr. Birdi’s leadership, the clinic’s outcomes are among the best in Europe, with an impeccable patient safety record.
What truly sets our clinic apart is the combination of world-class surgical skill and personalised, compassionate care. Mr. Birdi’s patients frequently comment on his calm, confident, and reassuring manner and the exceptional support of his team. Our clinic has a 100% 5-star rating from patients on independent review platforms, reflecting the consistency of excellent care. We strive to make each patient feel informed and supported every step of the way – from the first consultation (or second opinion) through surgery and recovery. When you are treated at The Keyhole Heart Clinic, you’re not just a number; you’re cared for by a hand-picked team of specialists (surgeons, cardiologists, anaesthetists, and nurses) who work together to tailor the best treatment plan for you. This team-based, patient-centric approach ensures that whether it’s a straightforward valve repair or a complex valve-and-aorta reconstruction, you receive the optimal solution for your condition.
A Leading Centre for Valve-Sparing and Minimally Invasive Surgery in the UK
The Keyhole Heart Clinic is proud to be at the forefront of heart valve surgery in the UK, attracting patients from across the country and around the world who seek the latest surgical techniques. We regularly treat patients with bicuspid aortic valve disease and have expertise in managing the associated aortic root aneurysms with minimally invasive solutions. In fact, our institution is regarded as the Number 1 in the UK for experience in keyhole heart surgery. For patients, this means you have access to a level of experience that is hard to match – our surgeons have seen and solved cases very similar to yours, and we bring that wealth of knowledge to each consultation.
Mr. Inder Birdi serves as a key opinion leader in valve-sparing aortic root surgery and teaches these techniques to other surgeons. He co-founded The Keyhole Heart Clinic specifically to make these cutting-edge treatments more accessible. Under his care, you can be confident that all feasible options – from bicuspid aortic valve repair to valve-sparing root replacement to advanced minimally invasive heart surgery – will be considered and discussed with you. Our mission is to achieve the best outcome with the least invasive approach necessary, so you can get back to living your life with a healthy heart as quickly as possible.
In Summary
A diagnosis of bicuspid aortic valve and an enlarging aortic root can be frightening for any patient or family. However, the outlook today is very promising. With procedures like the David procedure (valve-sparing aortic root replacement), it’s often possible to fix the problem and preserve your own heart valve, avoiding some of the compromises of traditional surgery. And with keyhole heart surgery techniques, even major cardiac operations can be done with smaller incisions, resulting in a faster and easier recovery. The Keyhole Heart Clinic in the UK brings these advances together – offering world-class expertise in valve-sparing, minimally invasive cardiac surgery in a patient-friendly, caring environment.
If you or your loved one has been told you have bicuspid aortic valve disease, aortic root aneurysm, or have been recommended for valve or aortic surgery, we are here to help. We welcome you to reach out for a consultation or second opinion. Our goal is to ensure you understand all your options – whether it’s a conventional surgery or a state-of-the-art minimally invasive solution – so you can make the best decision for your heart health. With the right treatment plan and the right team by your side, you can look to the future with confidence, knowing your heart is in expert hands.
