Aortic Valve Surgery
Topic Summary
The aortic valve is the valve between the main vein of the aorta and the left ventricle, where blood is sent to the body in the great circulation, which is the circulation of clean blood of the heart. Aortic valve surgeryIt is applied to the patient if the physician deems it appropriate. As a result of rheumatic diseases or being born with two leaflets, as the age progresses, the valve structure thickens and its movements are impaired. In later stages aortic valve disease In other words, stenosis and insufficiency occur in the valve. Palpitations that occur with exertion are the most obvious symptom. It has an insidious course and can cause heart enlargement and heart failure. Therefore, surgery should be performed on time.
Aortic Valve Surgery
Minimally invasive techniques have been developed in the last 30 years, as aortic valve repair and replacement surgeries are routinely performed in the old open heart surgery manner by making a 35-40 cm incision of the bone of faith and the delay in bone union due to the high number of complications. The practice of removing the aortic valve by entering the aorta and replacing it with a new valve for 50-60 years has provided great experience and allowed the development of new types of heart valves.
Today, the successful application of minimally invasive (armpit minithoracotomy) techniques and advanced bileaflet (double-leaflet) metal and biological heart valves have greatly increased the success rate in these surgeries. The surgeries performed extend life by as high as 30-40 years. Aortic valve repair and replacement surgeries can be performed with minimally invasive techniques (right armpit, anterior minithoracotomy).
Operation Time
1-2 Hours
Recovery Time
2-3 months
Discharge Time
5-10 Days
We have demonstrated the many benefits of this technique, which we first started in 1997 and published international scientific studies in 1999, 2001 and 2004. Among these benefits; The patient's early return to daily life. It is especially preferred by physically working patients. Other benefits include patients being discharged early, not having to protect their chest, being able to sleep on their side, having a very low risk of infection, and being able to drive a vehicle.
The benefits during the hospital period are; Complications such as bleeding and infection are few, the intensive care unit stay does not exceed 24 hours, and the hospital stay is 4-5 days. The only disadvantage for the patient is that the early pain is slightly more than that of routine heart surgery. The reason is that the outer membrane of the lung is sensitive to pain. But after 8-10 hours, there is no pain. Made with this technique aortic valve surgery During the procedure, the chest is entered through the right armpit minithoracotomy and the aortic valve is accessed by connecting it to the heart-lung pump. In heart valves that are not excessively calcified, expansion and/or repair can be performed, or the aortic valve can be removed and replaced with a metal or biological valve.
Its application, especially in patients without lung problems, not only reduces complications but also reduces the risk of heart surgery in case a second surgery is required later in life. Patients with aortic valve repair can easily undergo open heart surgery when valve replacement is required after 15-20 years. This is another advantage that extends life.
All About Aortic Valve Disease
Prof. Dr. Yavuz Beşoğul
The aortic valve, one of the four valves in the heart, is the valve through which clean blood from the left ventricle passes before spreading to the body through the aorta. It ensures that blood flows in the right direction and does not flow backwards. Problems such as aortic valve stenosis and aortic valve insufficiency may occur. Depending on the condition of the problem in the aortic valve aortic valve repair or aortic valve replacement are among the treatment options.
Over 20 Years of Experience
Having More than 20 Years of Experience in the Field of Cardiovascular Surgery Prof. Dr. Yavuz Beşoğul, He Has Improved The Health And Cured Many Patients.
Is Surgery the First Response to Patients with Aortic Valve Stenosis or Insufficiency?
The narrowing of the aortic valve makes it difficult for blood to flow healthily throughout the body. Aortic insufficiency means blood comes from the aorta towards the heart. In some cases, patients have both stenosis and insufficiency in the aortic valve. In order to decide on the intervention to be applied in aortic stenosis or aortic insufficiency, the patient's complaints should be taken into consideration first. Aortic valve disease, stenosis or insufficiency reaching critical levels affects the decision for surgery.
Aortic Valve Disease Treatment Methods
Stenosis may occur as a result of calcification, and sometimes failure due to connective tissue disorder causes the heart to become extremely enlarged. While both stenosis and insufficiency will enlarge the left side of the heart, the strength of the heart muscle decreases as a result of the dysfunction of a heart that is blocked in front. If the period is delayed too much, if timely intervention is not performed or surgery is not performed in time, the heart enlargement reaches the stage of advanced heart contraction disorder called cardiomyopathy, which puts the patient at a very high risk for the next surgery. The primary important criterion is that the heart muscle does not thicken and the heart does not enlarge.
In the treatment of aortic valve diseases, the heart valve is sometimes repaired with advanced techniques and sometimes completely replaced. This means that the heart valve is repaired or replaced with minimally invasive surgical techniques, with a small 4-centimeter incision on the side, under the arm, or, if the lungs are bad, with a small 4-5 centimeter incision in the front. The important thing is timely intervention, timely detection and not causing excessive heart enlargement.
Things to Consider After Aortic Valve Surgery
One of the most important issues after aortic valve replacement is that patients use blood thinners regularly as recommended by the physician. While the use of blood thinners for biological valve replacement is 3 months, patients must use blood thinners for life in mechanical valve replacement. In addition, it is extremely important to protect the patient from infections.
In cases such as surgical interventions that may be due to another disease, the patient should contact the heart doctor and take preventive measures against infection. However, the patient should regularly attend physician checks where the heart and heart valves are monitored. Since aortic valve diseases cause the heart to enlarge, early diagnosis and treatment is extremely important.
Location
Merkez, Hastanesi Sokak No:2, 34245 Gaziosmanpaşa/İstanbul
Contact
dryavuzbesogul.com
Our watches
Aortic Valve Repair
In order to eliminate the problem in the patient's aortic valve, if the condition of the valve is suitable, aortic valve repair is preferred first. Because it is better for the patient to continue his life with his own valve than to have it replaced with an artificial heart valve. In cases where aortic valve disorders are not severe, the aortic valve can be repaired and treated. In order to be used for aortic valve repair, the heart valve leaflets must be regular, there must be no stenosis with heart valve leakage, there must be no clot or roughness on the valve, the valve leaflets must be able to approach each other easily, or the valve leaflets must not leak backwards when the stenosis can be opened.
Contact Us
Aortic Valve Replacement
Aortic valve replacement is the replacement of the aortic valve with biological or mechanical artificial valves, which is applied in cases where the patient's aortic valve stenosis and insufficiency cannot be resolved by repair. It may be necessary to replace the valve in cases such as severe regurgitation or severe stenosis of the heart valves, sometimes both together, severe calcification of the valve, clot in front of the valve, or heart rhythm disturbance.
Prof. Dr. Academic Statements from Yavuz Beşoğul About Aortic Valve Surgery
Aortic valve surgery; It occurs by repairing or replacing the heart valve at the aortic outlet. Thanks to his experience in heart valve surgeries for many years, artificial valves have improved greatly and he has contributed to the development of surgical techniques. The most preferred metallic heart valves today have a bi-leaflet carbometal structure and are long-lasting, although they require anticoagulant. In addition, biological valves made from bovine or porcine pericardium have been developed for those who cannot use anticoagulants, such as the elderly or patients considering pregnancy. Aortic valve replacement or repair has been performed by sternotomy for many years. Due to the complications of sternotomy, aortic valve surgeries began to be performed with anterior or anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller. In 1997, we first started performing our surgeries by converting them to subaxillary incision in our country and contributed to the national and international literature in series.
Advantages of Aortic Valve Repair
Actually aortic valve repair Although there is no difference in the surgical technique, the entry technique has proven to be advantageous from bleeding to infection and early return to daily life. It reduces complications, especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective. On the other hand, the entrance site of the surgery provides excellent visibility and access, especially in terms of the exposure of the aortic valve. This is another factor that reduces complications. In patients requiring aortic and mitral valve replacement, since the rib spacing is different in terms of access to each valve, performing aortic and mitral valve, or double valve, surgery may prolong the time and disrupt the chest structure and cause the ribs to break, which creates postoperative respiratory problems. Briefly; Aortic and mitral valve surgery should not be performed with this technique.. In such cases, a frontal incision, that is, ministernotomy, is more useful and there is no entry site complication.
Surgery Technique
The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; That is, an anterolateral thoracotomy position is given with the chest on the right side. Aortic valve surgery During the procedure, a vertical 6 cm incision is made on the intersection of the subaxillary line and the right breast line, the pectoralis major and pectoralis minor muscles are dissected without cutting and a retractor is placed. For the aortic valve, the thorax is entered through the 3rd intercostal space and right lung ventilation is turned off or, if not tolerated, tidal volume is adjusted. is deducted. The pericardium opens and its leaves hang on the chest wall. Aorta, right and left atrium are clearly seen. After returning the aorta with the pedicle, it is suspended and the aorta, right auricle, and right atrium are easily cannulated. The patient is connected to the heart-lung pump, extra-corporeal circulation is transferred, ventilation is stopped and an x-clamp is placed on the aorta. Cardiac arrest is achieved by applying cold blood cardioplegia and topical cold saline. Aortotomy is performed at the aortic root and the aortic valve is clearly observed.
Postoperative
After the repair or replacement is made, the aotomy is closed. The patient is warmed, the heart is defibrillated if necessary, and after starting, the pump flow is gradually reduced and stopped. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (the location of the drain is important to avoid pain), the ribs are brought closer, and the muscles, subcutaneous and skin are closed properly. Postoperative follow-up is the same.
While this intervention technique can be applied to every patient, it is not preferred only in some cases. These:
- Those with advanced lung problems
- Those over 75 years of age,
- Double valve replacement (Aortic and Mitral) required,
- It should never be applied to patients requiring aortic valve surgery for the second time.
Frequently Asked Questions About Aortic Valve Surgery
Complaints of Aortic Valve Patients
Complaints of aortic valve patients include shortness of breath, fatigue and palpitations. We can list the complaints of aortic valve patients as follows;
Diagnosis of Aortic Valve Disease
The test that should be performed in the definitive diagnosis of aortic valve disease is ultrasound, that is, echocardiography, of the heart. Echocardiography allows imaging of the internal structure and functionality of the heart.
Causes of Aortic Valve Disease
Aortic valve diseases may occur for the following reasons.
- Congenital bi-leaflet aortic valve
- Rheumatic subsequent calcification of the aortic valve
- It is the occurrence of a valve leakage and failure to close, which occurs congenitally as a result of connective tissue failure and manifests itself in advanced ages.
For detailed information, you can visit our relevant blog post. What are the causes of aortic insufficiency?
Symptoms of Aortic Valve Disease
Aortic valve disease is a disease that progresses insidiously. Symptoms that occur due to stenosis or insufficiency in aortic valve diseases are:
- Shortness of breath
- Don't get tired easily
- Palpitation
- arrhythmia
- chest pain
- sudden fainting