Aortic Valve Disease – Repair and Surgery

Aortic Valve Disease – Repair and Surgery

Aortic valve disease is a condition in which aortic valve doesn’t function properly. Aortic valve is present between the left ventricle and the aorta (supplies blood to the entire body).

Aortic valve disease can be congenital (present at birth) or acquired (result from other causes). It can occur either due to leaking or narrowing of the aortic valve opening.

• Aortic stenosis is the narrowing of the aortic valve opening which restricts the blood flow from the left ventricle to the aorta.
• Aortic regurgitation (AR) is the leaking of blood back to heart.

In AR, valve repair is the first choice because it preserves valve strength and function and reduces the chances of infection. However, in case if the valve cannot be repaired, valve replacement is performed. Aortic valve replacement is the gold standard for the management of patients with severe aortic stenosis.

Aortic valve replacement or repair depends on the following factors:

• Severity of aortic valve disease
• Age
• Overall health condition

Aortic valve replacement can be done by open heart surgery or through catheter-based therapy (without open surgery) which is called as transcatheter aortic valve replacement or implantation (TAVR or TAVI).        

Transcatheter Aortic Valve Replacement or Implantation:

Transcatheter aortic valve replacement or implantation (TAVR or TAVI) is a minimally invasive procedure designed to replace a diseased aortic valve. A fully collapsible replacement valve is placed in the site through the catheter. It is recommended for patients with intermediate or high-risk complications from surgical aortic valve replacement (open heart surgery).

In this procedure, a catheter is inserted in the femoral artery (transfemoral approach) and guided into the chambers of the heart with the use of imaging techniques. There are two kinds of valve i.e. balloon valvotomy and self-expandable. In balloon valvotomy or valvuloplasty, a balloon present at the catheter’s tip is expanded to press the replacement valve into the place. The catheter is removed after ensuring that the valve is placed securely in its position. The other method is selfexpanding valve which expands on its own at the site of aortic valve when the catheter is moved back slowly.

The procedure takes place in a cardiac catheterization lab. The heart valve placement itself takes 30 to 45 minutes and the whole procedure takes two hours including the preparation time. It is usually done keeping the patient in conscious state and most patients get discharged in 48 hours with no cuts and stitches.

After the surgery, regular follow-up is recommended to evaluate the functioning of the replaced valve. Blood-thinning medications to prevent blood clots may be prescribed if necessary.

TAVI procedure is usually done through transfemoral approach (leg artery). However, it can also be performed through a small incision in the hand, neck, or over the chest between the ribs.

Medication compliance and making healthy lifestyle choices such as being physically active, consuming healthy diet, and quitting smoking are essential to reduce the mortality risk and improve quality-of-life.