What is Aortic Valve Surgery - Minimally Invasive?
Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards. Aortic valve surgery is done to either repair or replace the aortic valve in your heart. An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation. An aortic valve that does not open fully will restrict blood flow. This is called...
Alternative Names
Balloon valvuloplasty; Mini-thoracotomy aortic valve replacement or repair; Cardiac valvular surgery; Mini-sternotomy; Ring annuloplasty - minimally invasive; Robotically-assisted endoscopic aortic valve repair
Risks
Risks for any anesthesia are: Reactions to medicines Breathing problems Blood clots in the legs that may travel to the lungs Infection, including in the lungs, kidneys, bladder, chest, or heart valves Bleeding Additional risks vary by the patient’s age. Some of these risks are: Irregular heartbeat that must be treated with medicines or a pacemaker Damage to other organs, nerves, or bones Heart attack, stroke , or death
What is Aortic Valve Surgery - Minimally Invasive?
Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.
Aortic valve surgery is done to either repair or replace the aortic valve in your heart.
- An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.
- An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.
Minimally invasive aortic valve surgery is done through much smaller incisions (cuts) than the large cut needed for open aortic valve surgery.
Alternative Names
Balloon valvuloplasty; Mini-thoracotomy aortic valve replacement or repair; Cardiac valvular surgery; Mini-sternotomy; Ring annuloplasty - minimally invasive; Robotically-assisted endoscopic aortic valve repair
Risks
Risks for any anesthesia are:
Additional risks vary by the patient’s age. Some of these risks are:
- Irregular heartbeat that must be treated with medicines or a pacemaker
- Damage to other organs, nerves, or bones
- Heart attack, stroke, or death
Outlook (Prognosis)
Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.
Biological valves tend to fail over time. But they have a lower risk of blood clots.
Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most people, and they reduce recovery time and pain.
Description
Before your surgery you will receive general anesthesia. This will make you unconscious and unable feel pain.
There are several different ways to do minimally invasive aortic valve surgery. Techniques include laparoscopy or endoscopy, robot-assisted surgery, and percutaneous surgery.
- Your surgeon may make a 2-inch to 3-inch-long incision (cut) in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided to so your surgeon can reach the valve. This allows the surgeon to reach your heart and aortic valve.
- For the endoscopic, or “keyhole, approach, your surgeon makes 1 to 4 small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
- For robotically-assisted valve surgery, the surgeon makes 2 to 4 tiny cuts (about ½ to ¾ inch) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a 3-dimensional view of the heart and aortic valve on the computer. This method is very precise.
You will not need to be on a heart-lung machine for any of these surgeries, but your heart rate will be slowed by medicine or a mechanical device.
If your surgeon can repair your aortic valve, you may have:
- Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
- Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.
If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:
- Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
- Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.
Once the new or repaired valve is working, your surgeon will
- Close the small cut to your heart or aorta
- Place catheters (flexible tubes) around your heart to drain fluids that build up
- Close the surgical cut in your muscles and skin
The surgery may take 1 to 3 hours.
Aortic valve surgery is also now being done through a groin artery. No incisions are made on your chest. The doctor sends a catheter (tube) with a balloon attached on the end to the valve. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.
Why the Procedure Is Performed
Aortic valve surgery is done when the valve does not work properly. Surgery may be done for these reasons:
- Changes in your aortic valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.
- Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.
- Your heart valve has been damaged by endocarditis (infection of the heart valve).
A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.
Recovery
After your operation, you will spend 3 to 7 days in the hospital. You will spend the first few hours in an intensive care unit (ICU). Nurses will monitor your condition constantly.
Usually within 24 hours, you will be moved to a regular room or a transitional care unit in the hospital. You will slowly resume some activity. You may begin a program to make your heart and body stronger.
You may have 2 to 3 tubes in your chest to drain fluid from around your heart. These are usually removed 1 to 3 days after surgery.
You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines for fluids. Nurses will closely watch monitors that display information about your vital signs (pulse, temperature, and breathing). You will have daily blood tests and EKGs to test your heart function until you are well enough to go home.
A temporary pacemaker may be placed in your heart if your heart rhythm becomes too slow after surgery.
Once you are home, recovery takes time. Take it easy, and be patient with yourself.
References
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular interfention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.
Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
