Your heart contains four valves to regulate how blood flows between it and other areas of your body, with one called the aortic valve serving to circulate oxygenated blood out. A damaged aortic valve may lead to discomfort or shortness of breath in some people.
Your doctor and you will collaborate to decide if biological (made from animal heart tissue), mechanical or both valves will best meet your needs. While biological valves may not last as long, they do not necessitate lifelong blood-thinning medication.
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What is a minimally invasive aortic valve replacement?
Aortic valve replacement surgery entails replacing a defective heart valve to help ensure blood flows smoothly from your heart into the rest of your body. Your physician may advise undergoing this procedure if you have an illness that causes your aortic valve to become damaged or leaky (aortic stenosis or regurgitation). Signs and symptoms include heavy chest discomfort, trouble breathing, and tiredness – therefore replacement should take place as early as possible before any severe symptoms develop.
Some doctors offer alternative approaches for surgical aortic valve replacement that don’t involve cutting through the breastbone (sternum). At UT Southwestern, Neelan Doolabh, MD, and his team specialize in minimally invasive aortic valve repair and replacement using only 2-inch incisions between your ribs to achieve quick recoveries and improved results than conventional open surgery procedures.
Your doctor will connect your new aortic valve to the aorta via an artificial ring called a graft made of tissue from your rib cage or breast bone ring, as well as repair the existing aortic valve if necessary. He or she may use cameras or other equipment to monitor what’s happening inside your body during this procedure.
Surgery to replace an aortic valve can be an intensive and delicate process; not everyone may qualify. Your doctor will take into account factors like age, health history, and severity of symptoms when selecting an approach to take.
At a minimally invasive aortic valve surgery, you will be placed on a heart-lung machine, which takes over your heart and lungs during surgery. Once the surgeon has installed your new aortic valve, the heart-lung machine will be turned off and you will be transferred to a recovery room where you will receive instructions on how to care for yourself after the procedure has taken place. Your doctor may provide specific care instructions as you recover after surgery; typically relief occurs shortly thereafter.
What are the risks of minimally invasive aortic valve replacement?
Symptoms of nonfunctional heart valves could require surgery to replace or repair them. Open-heart surgery is the standard solution, typically taking between 2-4 hours; but for older or frailer individuals there may be alternative procedures with smaller cuts and shorter hospital stays available.
Your aortic valve opens each time your heart beats to send blood from your heart out into your largest artery – the aorta – where it flows to be oxygenated by blood flowing in its proper direction and away from back into your heart. If it no longer closes properly, heart valve replacement might be necessary and your doctor can choose either mechanical or tissue valves (warfarin (Coumadin). Tissue valves typically only last 7-15 years but don’t require lifelong anticoagulant medication like warfarin (Coumadin).
Minimally Invasive Aortic Valve Replacement utilizes an approach that doesn’t involve cutting across your chest in one long incision called a “sternotomy.” Instead, your surgeon might make 2-3 inch incisions on either side using techniques called mini-thoracotomy or hemi-sternotomy to replace it with less risk of complications including wound infection, respiratory issues, blood transfusions, and prolonged mechanical ventilation in intensive care units and hospitals.
Not all doctors are skilled at performing this type of surgery; your physician should carefully discuss all risks and benefits so you can make an informed decision for yourself about what is best for your health.
Your doctor should know about any health condition that might hinder or increase the risks of surgery, such as diabetes or liver or kidney issues. Your medications may need to be adjusted before surgery; afterward, you’ll likely require bed rest. Your physician might ask you to start walking around your room before progressing onto short strolls down the hall and eventually outside of the hospital grounds.
What are the benefits of minimally invasive aortic valve replacement?
If the aortic valve doesn’t close properly, it may reduce blood flow out of your heart and into your body. Your doctor may suggest replacing it with an artificial valve; surgery to do this could alleviate symptoms like chest pain and breathlessness while helping your heart work more efficiently and lowering the risk of death and cardiovascular issues.
Traditional heart valve surgery typically requires making an incision on your chest or rib cage and can have more complications, while minimally invasive heart valve surgery offers faster recovery with reduced pain, trauma, blood loss, and infection risk.
Aortic valve replacement surgery can involve installing either an artificial aortic valve made of synthetic materials or replacing an existing one using surgery, repair, enlargement, and biological materials (such as human tissue or animal hearts).
Your doctor will discuss the advantages and disadvantages of each option available to you, while family members who need to understand your decision should also be made aware.
Your surgery will require general anesthesia, keeping you unconscious and free from pain. Following surgery, you may remain hospitalized for several days afterward – first spending time in intensive care, followed by being moved into regular rooms before needing medication to prevent infections and manage pain.
Before your surgery, it is recommended to refrain from smoking and drinking alcohol. Your physician may provide other instructions prior to and following your operation.
Regular visits will be necessary in order to monitor changes to your aortic valve or any heart problems, including echocardiogram or CT scan, will take place to inspect both your heart and blood vessels, along with routine tests for monitoring your blood pressure and cholesterol (such as complete blood count or lipid profile ). Surgery should not be conducted while pregnant or breastfeeding and you should inform your physician immediately if you suffer from bleeding disorders or take medications such as blood thinners.
How is minimally invasive aortic valve replacement performed?
The heart is home to four valves that regulate how blood flows between its chambers and out to the rest of your body, such as the aortic valve between the left ventricle (left pumping chamber of the heart) and the aorta (a large blood vessel that transports it) – your aortic valve opens so blood can leave your heart and closes tightly so it does not come back in, thus helping it reach all parts of the body normally. If it can’t open or close all the way or leaks back into the heart, this condition is known as stenosis while regurgitation (return of blood to the heart).
Minimally invasive aortic valve surgery requires making a smaller cut in your chest (incision). UT Southwestern is one of few centers nationwide to offer this technique, which also reduces time spent in surgery as well as hospital and intensive care unit stays.
Before your operation, general anesthesia will ensure you remain asleep and pain-free throughout the procedure. Your surgeon may shave around the breastbone where an incision will be made before making either a 2- to 3-inch (5.6-7.6-centimeter) cut on either the right or left side of your chest, known as mini-thoracotomy or hemi-sternotomy, as appropriate to allow access to the aortic valve.
Minimally invasive aortic valve surgery allows your surgeon to replace the diseased aortic valve with one made of artificial materials, with long-term success anticipated; your physician will monitor any signs of trouble throughout this procedure.
Some patients with milder disease in their aortic valves or who do not meet the criteria for open heart surgery may benefit from minimally invasive aortic valve replacement via minimally invasive catheter insertion through the groin into an artery that leads to the diseased valve and then threading it through to implant a replacement valve.
