What is aortic insufficiency?
The aortic valve divides the left ventricle from the aorta, the main artery that distributes blood throughout the body. The aortic valve is generally formed by three flaps, anchored to a fibrous ring, and in exceptional cases, it can be formed by only two flaps (bicuspid). Aortic bicuspid is not a disease in itself but becomes so when the valve is insufficient. The aortic valve allows the passage of oxygenated blood from the left ventricle towards the aorta, distributing it in all the organs.
Aortic insufficiency is a disease characterized by non-complete closure of the aortic valve with regurgitation of blood in the left ventricle and progressive dilatation of the heart.
What is aortic stenosis?
The aortic stenosis is caused by the incomplete opening of the valve, which therefore is an obstacle to the leakage of blood from the left ventricle, which hypertrophies to expel all the blood and therefore becomes overloaded with work.
The insufficiency and stenosis of the aortic valve can coexist in the same patient. Moreover, they can be both congenital (and therefore present from birth) and acquired (i.e., caused by illness after birth). The most frequent causes of stenosis or aortic insufficiency are – calcific degeneration, which mainly affects the elderly and is very common after the age of 70, and rheumatic disease. Frequently people with aortic insufficiency or stenosis do not experience any particular symptoms.
What is aortic valve repair or replacement surgery?
Surgery on the aortic valve should be performed before severe symptoms appear. It can be diagnosed, however, by undergoing regular cardiological checks using the echocardiogram.
The interventions on the aortic valve are divided into two fundamental groups – those of “plastic” or “repair,” in which the native valve is maintained and “replacement” interventions, in which the valve is replaced with a prosthesis (biological or mechanical). Aortic plastic surgery consists of repairing the valve to correct its pathology (insufficiency or stenosis) without replacing it. When possible, it is preferable to repair a valve instead of replacing it.
How is an aortic valve repair or replacement performed?
The operation is performed under general anesthesia, with minimally-invasive access, in consideration of different parameters such as age, valve lesion, physical constitution, and co-pathologies. The procedure is performed with the heart stopped, and for this reason, the heart-lung machine is used. Different repair techniques can be used individually or combined with each other to rebuild the valve and make it complete.
In cases where repair is not possible, the aortic valve is replaced with a mechanical or biological prosthesis. Mechanical prostheses have the advantage of being long-lasting, but require anticoagulant therapy; while biological prostheses, derived from tissues of animal origin, do not require anticoagulant therapy, but tend to degenerate over time. The choice of the type of prosthesis should be made considering life expectancy, the possibility of maintaining anticoagulant therapy and the patient’s lifestyle. Furthermore, in women of child-bearing age, the desire to have children may suggest the use of biological prostheses,
Is aortic valve repair or replacement surgery dangerous or painful?
In patients of advanced age or with associated pathologies of vital clinical importance, the operative risk of surgery can be considered too high. In these patients, alternative techniques can be used that allow the implantation of the valve through a catheter through the femoral vessels or through a small incision on the chest wall. These procedures are evaluated and approved by the heart team consisting of a cardiac surgeon, anesthesiologist and a hemodynamic cardiologist.
Usually, the risk of death associated with this procedure is about 2%, but for each individual patient, a risk assessment is necessary, taking into consideration age, general conditions and associated pathologies.
At the end of the operation, the patient is transferred to intensive care, where he remains in observation for 12-24 hours, before being transferred back to the general ward. About 4 or 5 days after surgery, the patient can be discharged from the hospital and moved to a cardiology rehabilitation center.
Before undergoing a critical surgery such as valve repair and replacement it is necessary to know who are the topmost surgeons in this field –
Dr. Prateek Bhatnagar
Sunshine Hospitals, Hyderabad
Dr. Purushottam Kale
Fortis Hospital, Mumbai
Dr. Sanjay Kumar Agarwal
Apollo Hospitals, Hyderabad
Dr. Rajendra Patil
Nanavati Hospital, Mumbai
Dr. K R Balakrishnan
Fortis Malar Hospitals, Chennai
There is no shortage of talented heart surgeons in India, and these are only a few illustrious names from the field.