An introduction to Aortic Valve Replacement
The heart is a remarkable organ, responsible for pumping blood throughout the body, ensuring that every cell receives the oxygen and nutrients it needs to function. One crucial component of this intricate system is the aortic valve, which allows blood to flow from the heart’s left ventricle into the aorta, the body’s largest artery.
However, the aortic valve can malfunction over time, leading to various cardiac issues. When the aortic valve becomes thickened and calcified, it fails to open properly leading to a very serious condition called aortic valve stenosis.
Sometimes, the aortic valve leaflets are weak and floppy causing it to leak over time in a condition called aortic valve regurgitation. Aortic valve replacement is a medical procedure designed to address these problems, and in recent years, keyhole heart surgery has emerged as a promising minimally invasive option.
Understanding Aortic Valve Replacement
Aortic valve replacement is a surgical procedure aimed at replacing a damaged or malfunctioning aortic valve with a new one.
Traditional vs. Minimally Invasive Approaches
Traditionally, aortic valve replacement is performed through open-heart surgery, which involves making a large bone dividing incision in the chest, called a sternotomy. The patient’s circulation is supported on a special device called a heart lung machine, and the heart is stopped for a short while to allow the surgeon to have unimpeded view of the diseased aortic valve.
Although this procedure is safe and effective, the breastbone division needs to be repaired with special stainless-steel wires and the healing takes 12 weeks. During this time, the patient must avoid any heavy lifting or exercise.
In recent years, advances in medical technology have led to the development of minimally invasive techniques for aortic valve replacement, with keyhole heart surgery being one of the most notable options. Here’s why keyhole heart surgery might be the best choice for some patients:
1. Smaller Incisions: Keyhole heart surgery, also known as minimally invasive heart surgery, involves making much smaller incisions compared to traditional open-heart surgery. These smaller incisions reduce the risk of infection, minimize scarring, and lead to less postoperative pain.
2. Quicker Recovery: Patients undergoing keyhole surgery often experience shorter hospital stays and faster recovery times. This means they can return to their normal activities sooner, improving their overall quality of life. In many cases, this surgery involves no broken bone and this means that the patient can return to normal activities so much quicker.
3. Reduced Risk: Minimally invasive procedures typically carry a lower risk of complications compared to open-heart surgery when performed by experienced teams. Published data from experienced units suggest decreased, pain, risk of bleeding, infection, and damage to surrounding tissues.
4. Improved Cosmesis: Smaller incisions result in less noticeable scars, which can be particularly important for patients concerned about their appearance post-surgery.
5. Minimized Trauma: Keyhole heart surgery causes less trauma to the chest and body, which can be advantageous for older patients or those with existing health conditions.
Transcatheter Aortic Valve Implantation (TAVI)
TAVI is a minimally invasive procedure where a new aortic valve is inserted into the patients’ diseased aortic valve through a catheter inserted typically through an artery in the groin (femoral artery).
This approach is suitable for certain high-risk patients who are not suitable for either traditional breastbone surgery, or minimally invasive aortic valve replacement. The advantage of TAVI is the avoidance of the use of general anaesthesia, does not need surgery, and avoids the use of the heart lung machine.
There are disadvantages such as increased risk of leak around the new valve, increased pacemaker requirement, and unknown durability of the new valve. This is why doctors will recommend surgery over TAVI if you are otherwise fit for an operation.
Treatment Options for Aortic Valve Replacement
There are several treatment options available for aortic valve replacement, depending on the patient’s individual circumstances and the severity of their valve disease. These options include:
- Traditional Open-Heart Surgery: This method remains a viable option for many patients, especially those with complex valve issues. It involves a sternotomy, where the chest is opened to access the heart.
- Keyhole Aortic Valve Replacement: This technique involves small incisions between the ribs, allowing access to the heart without the need for a sternotomy. Surgeons use specialized instruments to replace the aortic valve, offering the benefits of smaller incisions and a quicker recovery.
- Transcatheter Aortic Valve Replacement (TAVR): TAVR is a minimally invasive procedure where a new valve is inserted through a catheter, typically via the femoral artery. This approach is suitable for certain high-risk patients and those unable to undergo open-heart surgery.
Aortic valve replacement is a crucial procedure for individuals with aortic valve disorders, and it’s essential to explore the various treatment options available.
While traditional open-heart surgery has been successful for many years, minimally invasive approaches like keyhole surgery are increasingly becoming the preferred choice for eligible patients due to their reduced invasiveness, faster recovery times, and lower risk of complications.
However, the choice of treatment should always be based on the patient’s individual medical history and the advice of their healthcare team. Advances in medical technology continue to offer new hope and better outcomes for those in need of aortic valve replacement.