Aortic Valve Repair
The heart has four valves, one for each chamber of the heart. The valves keep blood moving through the heart in the right direction. The aortic valve is located between the ventricles and the major blood vessels leaving the heart.
The aortic valve is comprised of several small flaps of tissue that control the flow of blood from the heart's left ventricle into your aorta, the body's largest artery. If the valve is seriously diseased or defective, and lifestyle changes and medication have not been effective, the valve may need to be surgically repaired.
Surgery on the aortic valve is common, and there are multiple ways to repair or replace a damaged or defective aortic valve. The two primary decisions the cardiac surgeon will consider are whether the valve can be repaired or must be replaced, and which surgical approach will work best.
In certain limited circumstances, especially if the valve is leaky rather than blocked, it may be possible to repair it using small tissue patches on the flaps of the valve.
In most cases of surgery on a damaged aortic valve, however, replacement rather than repair will be the best option. There are two primary kinds of replacement valves. Factors such as age and the overall state of the patient’s health will affect which type of valve is most appropriate:
- Mechanical valves are made of very durable artificial materials, including titanium, carbon, polyester, Dacron and Teflon, and are typically very long lasting. However, use of a mechanical valve usually requires patients to take blood-thinning medication (often referred to by the brand name of Coumadin) for the rest of their lives.
- Biological valves, also known as tissue valves or bioprosthetic valves, are made of animal tissue, often from a pig or a cow. With this type of valve, blood thinners are not usually required; however, biological valves have a limited life span of 10 to 20 years, so a second valve replacement operation may be required at some point. Biological valves are used in the majority of aortic valve replacement operations.
The appropriate surgical approach will depend on such factors as whether the valve can be repaired or must be replaced, how damaged it is, and the overall state of the patient’s health. The surgeon will determine which of the following procedures is most appropriate:
- Open-heart surgery to repair or replace an aortic valve involves making a seven- to 10-inch incision over the middle of the sternum, or breastbone, then dividing the sternum to allow access to the heart. In some cases a less invasive option, involving a slightly smaller sternal incision, is possible. Then the damaged valve is either repaired or replaced. In other cases, a technique known as axillary cannulation (or the insertion of a drainage tube, known as a cannula, in an artery in your armpit, or axilla) can allow aortic surgery to be performed without hypothermic circulatory arrest; this advance may reduce the incidence of postoperative strokes and neurological deficits.
- Transcatheter aortic valve replacement (TAVR) is a relatively new, minimally invasive option that may be appropriate in patients judged to be at high-risk for traditional aortic valve surgery.
- Composite graft surgery is an appropriate option if the aortic valve is damaged, and the part of the aorta closest to the heart (known as the aortic root) is affected by either an aneurysm or tear. This procedure involves both replacing the aortic valve with either a mechanical or a biological valve and repairing or replacing the damaged portion of the aorta itself.