Aortic Valve Surgery

The Aortic Valve
The aortic valve is one of four valves in the human heart. Problems with the aortic valve can be divided into two broad categories of functional disturbances. The valve opens during the contraction of the heart and during the relaxation period, the valve should close and be watertight. If the valve leaks when it should be closed, the patient suffers from aortic regurgitation. This causes the heart to work harder to pump extra blood to overcome the volume load it faces. If the valve becomes narrowed and obstructed due to fibrosis and calcification, not enough blood will get through the aortic valve and into the aorta, and the patient suffers from aortic stenosis. In either case, aortic valve disease will decrease the net amount of blood that can be ejected from the left ventricle to the whole body. This can be severe even in patients who have no symptoms, but usually causes problems such as increased fatigue, shortness of breath, swelling of the legs and possibly fainting episodes. Sudden death occurs rarely. Aortic stenosis is also a common cause of left ventricular hypertrophy. In this condition, the left ventricle has to work harder to pump blood across narrowed valve, and the heart will increase muscle mass in the same way a weight lifter will increase muscle mass.

Aortic Valve Disease
Aortic Valve disease can be a consequence of problems that have been present since birth (congenital heart defects) and problems that occur due to aging and wear and tear of the valve. The most common congenital heart problem affecting the aortic valve is a bicuspid aortic valve which means the valve has two components or cusps as opposed to the usual three cusps seen in the normal valve.This congenital heart problem occurs in around 2% of the general population. As a bicuspid valve ages, there may be problems associated with blood flow across a relatively inefficient valve or progressive leaking may occur and surgery may be necessary. The options would be to either replace or repair the valve.

The most common aortic valve problem associated with aging is aortic valve stenosis. As the valve ages, a person may get a buildup of calcification and fibrosis on the valve. This limits the ability of the valve to function properly and decreases the amount of blood flow to the brain and the rest of the body. The valve usually needs to be replaced in this condition.

Aortic Valve Replacement
If there is a problem with the aortic valve, the surgeon can conduct aortic valve replacement or aortic valve repair surgery. If aortic valve replacement is necessary, we offer a number of replacement options. These include replacement with a bioprosthetic (either pig or calf) valve, a mechanical valve, a cadaver valve, or the complex and difficult Ross Procedure. In the Ross Procedure, the patient’s pulmonary valve is removed and transferred to replace the aortic valve and the pulmonary valve is replaced with a cadaver pulmonary valve. Other valve options include replacing the valve and surrounding tissue with a stentless bioprosthetic valve. The decision to replace or repair a valve, and the type of valve to be used, requires a careful review of each patient's condition and should be discussed with a cardiac surgeon.

Minimally Invasive Aortic Surgery
Many of these replacement procedures can be performed minimally invasively via a minimally invasive mini-sternotomy.