Aortic Repair & Replacement
What are the treatment options for Aortic Valve Disease?
There are two types of aortic valve surgery: aortic valve repair and aortic valve replacement. Surgical options for either aortic stenosis or regurgitation include the implantation of a mechanical valve, a tissue valve, or your own valve (the Ross procedure). Aortic valve surgery can be performed using traditional heart valve surgery or minimally invasive approaches.
Transcatheter Aortic Valve Replacement (TAVR) is another option for some cases of aortic regurgitation. TAVR is a procedure in which doctors access the valve by passing tools through the bloodstream.
What kinds of valves are used in Aortic Valve Replacement Surgery?
Mechanical valves, Biological Valves, and Homograft Valves are used in aortic valve replacement surgery.
- Mechanical valves are made completely of mechanical parts, which are tolerated well by the body. The bileaflet valve is used most often. It consists of two pyrolite (qualities similar to a diamond) carbon leaflets in a ring covered with polyester knit fabric. People with mechanical valve prostheses need to take an anticoagulant medication, such as warfarin (Coumadin), for the rest of their life to reduce the risk of blood clotting and stroke.
- Biological valves (also called tissue or bioprosthetic valves) are made of tissue, but they may also have some artificial parts to provide additional support and allow the valve to be sewn in place. Biological valves can be made from pig tissue (porcine), cow tissue pericardial (bovine), or pericardial tissue from other species. These valves allow patients to avoid lifetime use of anticoagulants (blood thinning medications).
- A homograft (also called allograft) is an aortic or pulmonic valve that has been removed from a donated human heart, preserved, treated with antibiotics, and frozen under sterile conditions. Homografts are ideal valves for aortic valve replacement, especially when the aortic root is diseased or endocarditis (infection) is present.
The type of valve used typically depends on the severity of symptoms and other individual health concerns, such as age and the use of blood thinners.
What Surgeries and Procedures are Used to Repair or Replace the Aortic Valve?
There are several different approaches to correcting a damaged aortic valve, including traditional surgery, minimally invasive surgery, and TAVR.
- Traditional aortic valve surgery involves the surgeon making a 6- to 8-inch incision down the center of the sternum (breastbone). Part or total of the sternum is divided to provide direct access to the heart. The surgeon then repairs or replaces the abnormal heart valve or valves.
- Minimally invasive aortic valve surgery is performed through smaller, 2- to 4-inch incisions. This may reduce blood loss, trauma, and length of hospital stay. This is an option for most people, but a cardiac surgeon must review a patient’s diagnostic tests to be sure that they are a candidate for this type of surgery.
- TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure that is performed by inserting a thin tube (called a catheter) within a blood vessel—often the femoral artery near the groin. The catheter can be threaded up to the heart, and then a new aortic valve can be passed through the catheter and put into position to replace a narrowed one. TAVR is an option for most people who’s aortic stenosis requires treatment.
Aortic valve disease is often associated with enlargement (aneurysm) of the ascending aorta, the initial portion of the aorta (the main blood vessel in the body that originates from the aortic valve). If the enlargement of the aorta is substantial (usually above 4.5 or 5 cm in diameter), this part of the aorta may need to be replaced.
The David procedure allows surgeons to repair a leaky aortic valve and simultaneously replace an enlarged ascending aorta. Another option is replacement of the entire aortic root and aortic valve with a combination of a mechanical valve with an attached tube graft. Also called the modified Bentall operation, this approach is often used in younger patients or in those patients who wish to avoid reoperation. Anticoagulation therapy is required.
If I Need an Aortic Valve Repair or Replacement, What are My Next Steps?
If your primary doctor or cardiologist has brought up the possibility of an aortic valve repair or replacement, you should be seen by a cardiac surgeon to evaluate your candidacy for surgery and determine the best treatment approach for your unique case.
When it comes to aortic valve surgery, Columbia is a pioneer in the field. Our institution was behind the development of the TAVR procedure, and our program led the clinical trials that proved its effectiveness. We have a team of experts, and they are here to help you. Whether you need us to evaluate, operate or simply offer an opinion, we’re here to give you the best care possible.
If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-2633 or use our appointment request form.