The results of aortic valve repair surgery depend on the skill and experience of the medical staff, so Bimaristan Medical Center works to direct the patient to the best specialized cardiac hospitals in Turkey.
Overview of the aortic valve
The aortic valve (aortic valve) consists of three leaflets (cusps) that rest on the valve ring and separate the left ventricle of the heart from the ascending aorta.
The aortic valve opens in the systolic phase due to higher pressure in the left ventricle than in the aorta and closes in the diastolic phase due to lower pressure in the left ventricle and higher pressure in the aorta.
The aortic valve allows oxygen-rich blood to pass from the heart to the aorta, which carries it to all the arteries of the body, and prevents it from returning to the heart when the pressure in the left ventricle drops in each cardiac cycle.
If the aortic valve doesn’t function well, it affects blood flow and the amount of blood delivered to the body decreases, causing the heart to pump harder to deliver blood throughout the body, which may lead to the need for aortic valve repair surgery to restore proper valve function.
Types of aortic valve disease
There are two main types of aortic valve disease:
- Aortic valve insufficiency (or aortic valve regurgitation): In this condition, the aortic valve doesn’t close completely, allowing blood to return to the heart.
- Aortic valve stenosis: In this condition, the aortic valve is narrow and does not open wide enough to allow blood to leave the heart and spread throughout the body.
Aortic valve disease may be congenital, or the valve may become diseased with age.
Bicuspid aortic valve is the most common congenital aortic valve disease, occurring in 1–2% of the population; the presence of two leaflets instead of three prevents the valve from opening and closing completely, and although the condition is present from birth, symptoms may not appear until adulthood, often requiring aortic valve repair surgery to restore proper valve function.
Acquired aortic valve disease occurs when the valve is continuously damaged, calcium builds up on the valve, and makes the leaflets hard and narrow, limiting their movement.
Aortic valve repair or replacement?
If the aortic valve issue is mild, it can be treated with medication or may not need to be treated at all, but in some cases, aortic valve repair surgery or replacement is necessary.
Aortic valve repair surgery is now considered an alternative option to valve replacement. It aims to restore normal aortic valve shape and function and is most commonly used in patients with aortic valve insufficiency, proximal aortic aneurysm, or congenital aortic stenosis.
Although aortic valve replacement is the routine treatment for severe aortic valve insufficiency, aortic valve repair surgery, though less common, has several advantages that make it preferable to replacement in certain suitable patients.
Aortic valve repair surgery is preferred for aortic valve insufficiency because it reduces the risk of blood clots, septic endocarditis, and other infections associated with the use of replacement valves. Additionally, repairing a damaged valve is easier than replacing it, and recovery after the operation is faster.
Surgeons also favor aortic valve repair surgery over replacement when aortic valve insufficiency is linked to a nearby aortic aneurysm, which can negatively affect valve function.
Studies have shown that if aortic valve repair surgery is performed accurately and by experienced doctors, the results are better than aortic valve replacement, with a lower mortality rate and fewer complications.
Other studies have reported that the survival rate after aortic valve repair surgery is approximately 96% at 1 year, 92% at 5 years, and 83% at 10 years.
Methods used in aortic valve repair surgery in Turkey
The method of aortic valve repair surgery varies according to the type of damage, as the procedure aims to restore the normal anatomical structure of the aortic valve, leading to an almost complete restoration of valve function for a relatively long period of time.
Open-heart aortic valve repair surgery is usually performed to gain a clearer view of the complex geometry of the valve, while minimally invasive techniques may limit the ability to accurately assess the valve’s shape.
As with valve replacement, the patient undergoing aortic valve repair surgery is placed under general anesthesia and connected to a cardiopulmonary bypass machine. The heart is then stopped to allow accurate analysis and precise repair of the aortic valve.
There are many techniques used to perform aortic valve repair surgery, depending on the type and location of the damage or disease affecting the valve. Ongoing research continues to explore new methods that may further extend patient life expectancy and improve quality of life.
It is essential to choose a medical team specialized in aortic valve repair surgery, as the outcome largely depends on the team’s expertise and experience. Bimaristan Medical Center helps guide patients in selecting the best hospital and surgical team to ensure optimal results and care.
Some of the current techniques used in aortic valve repair surgery include:
Changing the shape of the aortic valve leaflets
The shape of the valve leaflets is controlled, and tissue growths are removed to make them fit tightly together when the valve is closed.
Two tricuspid aortic valve leaflets can be sewn together, changing the shape of the valve to resemble a bicuspid valve. This method is used to repair aortic valve insufficiency and cannot be used in the case of aortic valve stenosis or a congenital bicuspid aortic valve.
Repairing aortic valve tears and holes
If the aortic valve leaflets have tears or holes, the surgeon can repair them using tissue grafts.
Aortic ring annuloplasty
This technique is used when the aortic valve annulus dilates, causing the leaflets to spread apart and causing aortic valve insufficiency.
A special prosthetic ring is placed around the aortic valve to reinforce the aortic valve ring, increase its stiffness, and restore its normal size to further seal the valve.
Studies have shown that the long-term results of this technique are satisfactory in the treatment of this condition.
Aortic root replacement with valve preservation (David Procedure)
This procedure specializes in treating aortic root aneurysms without replacing the aortic valve, replacing the Bentall procedure, which involved replacing the aneurysm with the aortic valve, whether the valve was damaged or intact.
In this procedure, the aortic valve is extensively removed from its location and then reimplanted with an aneurysm replacement graft, so this procedure is also called “aortic valve reimplantation”.
Balloon valvuloplasty
It is a minimally invasive technique usually usedto repair mitral valve stenosis and rarely used to repair aortic valve stenosis, in which a small catheter with an expandable balloon at the tip is inserted into the heart, and when the balloon reaches the aortic valve, it is inflated to expand the valve and separate the leaflets from each other.
What happens after aortic valve repair surgery?
The shape of the aortic valve must be carefully assessed after aortic valve repair surgery; if one leaflet is overly dilated, it may result in aortic valve prolapse that progresses to aortic valve insufficiency if left untreated.
After the operation, the patient is transferred to the intensive care unit to spend at least one day, then transferred to a regular hospital room to stay there for several days, and the length of hospitalization varies according to the technique used to repair the aortic valve.
During your hospitalization, the medical staff will monitor your vital signs, make sure there is no infection at the incision site, and manage your post-operative pain.
The patient will also be helped to get out of bed and walk gradually, and the recovery time depends on the type of procedure used to repair the valve, the patient’s health condition before the operation, and any complications during or after the surgery.
After discharge from the hospital, the patient may need to take some medications and will need to visit the doctor’s office on a regular basis for check-ups, monitoring, and evaluation of the aortic valve.
It is not necessary to take blood-thinning medications after aortic valve repair surgery, as in aortic valve replacement, but blood thinners may be necessary if the patient has atrial fibrillation to prevent blood clots from forming in the left atrium.
The patient should make changes in his life to reach a healthy lifestyle, such as exercising, eating a healthy, balanced diet, avoiding physical and psychological stress, and quitting smoking, all of which will help the patient recover faster and minimize the risks and complications that can occur in the future.
Studies show that only 1 out of 10 patients who undergo aortic valve repair will need reoperation within the first 10 years after the procedure, and that the durability of the aortic valve repair was excellent, especially in patients who had the aortic valve annulus reinforced.
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