Aortic valve replacement
| Aortic valve replacement | |
|---|---|
| Intervention | |
| ICD-9-CM | 35.21-35.22V43.3 |
Aortic valve replacement is a procedure in which a patient's failing aortic valve is replaced with an artificial heart valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency) or partially blocked (aortic stenosis). Current aortic valve replacement approaches include open heart surgery via a sternotomy, minimally invasive cardiac surgery (MICS) and transcatheter aortic valve replacement (TAVR).
As risk of aortic valve surgery has decreased and long term data on the survival and quality of life of patients for patients after valve replacement has become available, evidence-based guidelines for aortic valve replacement have been developed. The American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease are a widely accepted source of information for cardiologists and surgeons.
Patients with severe aortic stenosis, where the aortic valve is narrowed and blood flow from the heart is obstructed are candidates for surgery when they develop symptoms or when the heart function is impacted. Certain asymptomatic patients may also be candidates for surgery, especially if exercise stress testing is positive.
Patients with leaky aortic valves (aortic insufficiency) often tolerate even severe degrees of insufficiency for a relatively long time before symptoms develop. Surgery is indicated for symptoms such as shortness of breath, and in cases where the heart has begun to enlarge (dilate) from pumping the increased volume of blood that leaks back through the valve.
There are two basic types of artificial heart valve: mechanical valves and tissue valves.
Tissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.
There are alternatives to animal tissue valves. In some cases a homograft - a human aortic valve—can be implanted. Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves. Another procedure for aortic valve replacement is the Ross procedure (or pulmonary autograft). In a Ross procedure, the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.
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