Over the years, the aortic valve may suffer from insufficiency or stenosis during its operation. Aortic valve replacement surgery can be performed in Turkey and avoid many problems for the patient that may end in death.
Overview of the aortic valve replacement process
The aortic valve is one of the four heart valves that help blood flow throughout the body in one direction. When the aortic heart valve opens, blood passes from the heart, specifically from the left ventricle to the aorta (the largest artery in the body), and when it closes, it prevents blood from returning from the artery to the heart in the opposite direction. This process is repeated in every heartbeat.
The aortic valve can become damaged or diseased for a number of reasons that make it unable to function well. Doctors may recommend aortic valve replacement (AVR) as a definitive treatment for the condition when aortic valve repair fails or cannot be performed.
surgical aortic valve replacement (SAVR) involves removing a damaged or defective valve and replacing it with an artificial or biological valve from animal or human tissue that performs the valve's primary function in preventing blood from returning to the heart.
It is worth noting that the success rate of this operation is high and the risk of death from the operation is estimated at about 1% to 3%, and the operation is associated with a survival rate of about 94% after five years of the operation and 84% after ten years of the operation.
as that studies The benefit of performing aortic valve replacement in patients with aortic valve stenosis or insufficiency and its importance in improving the quality of life in these patients.
There are minimally invasive options for an aortic valve replacement surgery that include endoscope orcatheter Suitable for some patients, but aortic valve replacement withopen surgery It is usually the best and safest option.
Reasons for performing aortic valve replacement
The patient may have a problem with the aortic valve because of a congenital defect that he had since birth, or as a result of exposure to several factors over the years, or due to other heart problems such as septic endocarditis.
All of these reasons may lead to one of two situations:
- aortic valve stenosis; A condition in which the aortic valve is unable to open fully and the valve opening becomes narrow, resulting in a decrease in the amount of blood leaving the heart.
- aortic valve regurgitation; A condition in which the aortic valve becomes unable to close properly, causing blood to return to the heart and flow in the opposite direction.
These problems may cause shortness of breath, chest pain, fatigue, dizziness, fainting, edema of the feet and other symptoms that may threaten the patient's life such as heart failure if the aortic valve is not replaced as soon as possible.
A doctor may recommend aortic valve replacement even if the patient does not have severe symptoms because the operation is more effective if symptoms are not advanced.
Symptoms and signs of aortic valve injury
Patients may not notice disease or damage to the aortic valve for several years, and may see a cardiologist's office with one of the following symptoms:
- My chest pain eases while resting
- Lethargy or tiredness after exercising
- dyspnea after vigorous activity or when lying down
- Not eating enough (especially in children with aortic valve stenosis)
Methods for diagnosing diseases of the aortic valve
To diagnose aortic valve diseases, the doctor takes the clinical history from the patient by asking him about the symptoms he faced and his medical history, then he starts examining the heart and hearing its sounds using a stethoscope.
There are many tests that are used to detect diseases of the aortic valve, including:
- Echocardiography (echo): A technique that uses ultrasound in imaging the heart cavities during the pulse, detecting the condition of the aortic valve and the aorta, and helps determine the cause and severity of valve damage, and it is the most important diagnostic method for aortic valve diseases.
- Electrocardiogram: A technique that records the electrical activity of the heart used to detect heart failure caused by aortic valve stenosis.
- Simple chest photo: It is used to see the heart and lungs to detect an enlarged heart, which may be a sign of valvular problem or heart failure, in addition to detecting calcifications in the valve.
- Intensity test: In this test, the patient connected to the ECG machine walks on a treadmill or rides a stationary bike to increase the heart rate. This test helps see the heart's reaction to physical activity and detect symptoms of valvular damage during exercise.
- Cardiac catheterization: It is not usually performed to detect diseases of the aortic valve, but it may help determine the severity of the injury and diagnose the condition in the event that other tests fail to do so, and it also gives information about blood flow and heart health in general, some therapeutic procedures can also be done by cardiac catheterization.
- MRI: A technique that uses magnetized fluids and radio waves to produce a detailed picture of the heart, determine the severity of damage to the aortic valve, and measure the size of the aorta.
- Computed tomography: A technique that uses X-rays to produce cross-sectional images of the heart.
Risks of open aortic valve replacement surgery
There are certain risks when performing any surgery, and these risks differ from one patient to another depending on the general health condition, age and other factors, but most patients who underwent aortic valve replacement surgery had successful and satisfactory results.
Complications of an aortic valve replacement usually include:
- arrhythmia (irregular heartbeat)
- Kidney problems may persist for a few days after the operation
- Blood clots that lead to a stroke or heart attack
- Complications from anesthesia
There are some factors that increase the risk of complications and the risk of aortic valve replacement surgery in general, including:
- chronic diseases
- Other heart disease or problems
- lung problems
- obesity and weight gain
Aortic valve replacements
There are two main types of alternative aortic valves:
- prosthetic valves: These valves are made of carbon, metal or plastic. They are long-lasting, but they increase the risk of blood clots, so the patient must take blood-thinning medications for the rest of his life. The doctor will adjust the amount of fluids because a few of them do not prevent clots from forming and many of them may cause severe bleeding after No minor wound.
- Vital valves: They are valves taken from Animals or human corpses, It only lasts for 12-15 years but it does not lead to blood clots and you do not need to take blood-thinning medications.
The doctors will Bimaristan Medical Center Explain the benefits and disadvantages of each type of replacement valve and provide recommendations on the best option for each patient.
Preparing for an aortic valve replacement surgery
The patient will undergo some tests to ensure his health and ability to perform the operation, such as:
- Urinary and blood tests
- simple chest photo
- Clinical examination
The doctor must be informed of all medications and nutritional supplements that the patient is taking, and the doctor may recommend stopping some medications before the operation, and he must stop smoking for two weeks before the operation if he is a smoker to prevent respiratory problems and the formation of blood clots.
The doctor should also be informed if the patient has any disease, even if it is just a mild cold, because this will affect the healing process.
The patient may need to shower with a special germicidal soap the night before the operation, and in most cases the patient will not be allowed to eat or drink after midnight.
How is aortic valve replacement surgery performed in Turkey
The most common way to replace the aortic valve is open surgery Which usually takes two to four hours, and is performed under general anesthesia, meaning that the patient will be asleep during the operation and will not feel any pain at all.
Aortic valve replacement in Turkey is performed according to the following steps:
- The surgeon makes a longitudinal incision in the center of the chest 8-10 inches (20-25 cm) through the sternum to access the heart.
- The heart is connected to the cardiopulmonary bypass machine, which performs the function of the heart and lungs during the procedure, and then the heart is stopped.
- The damaged aortic valve is removed and replaced with a new valve, then the bypass machine is removed and the heart re-functioning.
- Finally, the surgeon attaches the sternum and closes the incision.
After the operation is completed, the patient is transferred to the intensive care unit, where he is monitored and ensured that there are no complications. For more details, see the operation bthe video.
This operation is performed on patients under the age of 40 or 50 years in the event that the patient does not want to use blood-thinning drugs for the rest of his life.
In Ross' operation, the patient's natural pulmonary valve is used to replace the damaged aortic valve due to their similar anatomical structure, and then the pulmonary valve is replaced with a lung graft taken from a donor heart and saved and frozen for the time of the operation.
A lung graft was used to replace the pulmonary valve in place of the damaged aortic valve because blood flows with less pressure through the pulmonary valve, which makes the replacement valve last longer if placed in place of the pulmonary valve.
The risk of blood clots and valve inflammation with this procedure is lower than when using a valve replacement, and it is a long-term solution to treating aortic valve disease.
Ross operation is a difficult and time-consuming procedure because it is performed on two heart valves, so it is performed on younger patients who can withstand the long operation time.
Healing after aortic valve replacement surgery
The patient needs to stay in the hospital after the aortic valve replacement surgery for about a week, although full recovery may take two to three months, and this depends on the patient’s age, health and the type of operation performed.
The patient will feel better immediately after the operation, and he can start doing daily activities gradually upon returning home, and every day will feel better than the day before.
Your doctor may suggest exercising or starting a cardiac rehabilitation program to aid recovery.
The patient may need 6 to 8 weeks to be able to do office work, while he usually cannot drive a car for about 4 to 6 weeks after the operation, and this depends on his speed of recovery and how well he adheres to the doctor’s instructions.
You can consult your doctor about activities that you can do and what you should avoid until the time of your recovery.
Other methods for aortic valve replacement
In some other cases, aortic valve replacement is performed withMinimally invasive laparoscopic surgery Which is characterized by a smaller wound and no damage to the sternum.
It can also TAVR Catheter Replacement By making a surgical incision in the groin and inserting the replacement valve through the femoral artery and connecting it to the site of the aortic valve through the catheter.
Although these procedures are less painful and shorten the hospital stay, minimally invasive surgery is not suitable for all patients, it is indicated only when it is not possible to perform open heart surgery.
The doctor will choose the procedure that is best in terms of results and the degree of risk to the patient.
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