Aortic Valve Surgery in Delhi

Your heart is a powerful pump, and healthy valves are essential for its optimal function. The aortic valve, the last valve encountered by oxygen-rich blood leaving the heart, ensures blood flows in the right direction and doesn’t leak back into the left ventricle. Aortic valve problems demand prompt medical attention, often requiring surgery to restore valve function and alleviate symptoms.

Mcurehealth Hospitals: Committed to Advanced Aortic Valve Surgery

At Mcurehealth Hospitals, our dedicated team of cardiovascular specialists leverages their expertise and cutting-edge facilities to provide exceptional care for patients undergoing aortic valve surgery. We prioritize a patient-centric approach, crafting personalized treatment plans to achieve optimal outcomes for each individual.

Understanding Aortic Valve Surgery

Aortic valve surgery encompasses a range of procedures designed to repair or replace a diseased or damaged aortic valve. When the valve malfunctions, it can either narrow (stenosis), restricting blood flow, or leak backwards (regurgitation). Surgery aims to restore valve function, alleviate symptoms, and improve overall heart health.

Who Needs Aortic Valve Surgery?

Aortic valve surgery is typically recommended when medication or other conservative treatments fail to manage symptoms or prevent disease progression. It addresses various conditions affecting the aortic valve, including:

• Aortic Stenosis: A narrowed or obstructed aortic valve hinders blood flow from the left ventricle to the body. This narrowing can lead to chest pain, shortness of breath, and fatigue, potentially progressing to heart failure if left untreated.
• Aortic Regurgitation: Aortic valve leakage allows blood to flow backwards into the left ventricle with each heartbeat. This can cause symptoms like palpitations, dizziness, and difficulty exercising, and may increase the risk of heart failure over time.

Additionally, valve replacement may be necessary if the valve is damaged due to:

• Congenital heart defect
• Endocarditis (heart infection)
• Rheumatic heart disease
• Ageing/Degenerative process

Types of Aortic Valve Surgery

Aortic Valve Surgery: A Detailed Explanation

The aortic valve, located between the heart’s pumping chamber and the main artery, controls blood flow out of the heart. When this valve malfunctions, surgery becomes necessary to restore its function. Here’s a breakdown of the primary aortic valve surgery approaches:

Aortic Valve Replacement (AVR):

This procedure involves complete removal of the diseased aortic valve and implantation of a prosthetic one.

• Implanting a New Valve: Surgeons remove the damaged valve and carefully place a new artificial valve in its position. These replacement valves come in two main types:
• Mechanical Valve: Exceptionally durable, lasting many years, but requiring lifelong blood-thinning medication to prevent blood clots.
• Biological Valve (Bioprosthesis): Made from animal tissue (pig or cow), eliminating the need for blood thinners. However, bioprosthetic valves may have a shorter lifespan and might require future replacement.
• Choosing the Right Valve: The decision between a mechanical or biological valve depends on several factors:
• Severity of valve dysfunction: How significantly the valve is malfunctioning.
• Patient age and health: Younger patients might benefit from the durability of mechanical valves, while older patients or those with bleeding risks may prefer bioprosthetic valves.
• Anticipated valve durability needs: How long the patient is expected to live and whether future valve replacement is a concern.

Aortic Valve Repair (AV Repair):

This procedure focuses on preserving the native aortic valve structure.

• Repairing the Leaflets: Surgeons directly work on the valve leaflets (flaps) to restore their proper closure. This approach offers potential benefits:
• Preserves natural valve: Maintaining the native valve may lead to superior long-term hemodynamics (blood flow patterns) compared to replacement.
• Reduces future interventions: A repaired valve might not require future replacement procedures as often as a replaced valve.
• Suitability for Repair: AV repair is not always possible. The valve anatomy must be suitable for effective repair, meaning there should be no severe calcification or tearing of the leaflets.

Transcatheter Aortic Valve Replacement (TAVR):

This minimally invasive approach offers a revolutionary alternative to traditional open-heart surgery for aortic valve replacement.

• Catheter-Based Delivery: TAVR utilises a catheter system inserted through a blood vessel, typically in the leg or groin. This catheter delivers and deploys a new valve within the aortic annulus, the ring-like structure supporting the valve, without requiring a full chest incision.
• Target Population: Primarily suited for high-risk patients who may not be ideal candidates for traditional open-heart surgery due to factors like age, underlying health conditions, or specific anatomical limitations.
• Valve Options: Similar to surgical AVR, TAVR procedures currently predominantly use bioprosthetic valves due to their compatibility with the catheter delivery system.

Balloon Aortic Valvuloplasty:

This non-surgical intervention offers a temporary solution for narrowed aortic valves.

• Balloon Catheter Technique: A thin, balloon-tipped catheter is inserted through the vasculature and positioned across the stenotic (narrowed) aortic valve. Once inflated, the balloon widens the valve opening, improving blood flow.
• Application: Primarily a palliative procedure for symptomatic relief in select patients with severe aortic stenosis who are not suitable candidates for traditional surgery. This procedure does not offer a permanent solution, and repeat procedures might be necessary over time.

Aortic Root Replacement:

This extensive surgery involves replacing the entire aortic root, including the aortic valve, ascending aorta, and sometimes even the aortic arch.

• Complex Indications: This procedure is reserved for specific situations like:
• Aortic aneurysm or dissection involving the aortic root.
• Complex valve pathology extending to the root.
• Specific genetic conditions affecting the aortic root.

Choosing the Right Approach:

The optimal surgical approach depends on a comprehensive evaluation of the patient’s individual condition, including:

• Severity and type of valve dysfunction (stenosis, regurgitation, or both)
• Underlying cause of the valve disease
• Patient age and overall health status
• Anatomic considerations of the valve and aortic root

Through a collaborative decision-making process involving the cardiothoracic surgeon, cardiologist, and the patient, the most suitable and successful intervention for each individual can be determined.

What to Expect During Aortic Valve Surgery

Aortic valve surgery is a complex procedure involving meticulous planning, skilled surgery, and comprehensive follow-up care to ensure optimal outcomes. Here’s an overview of each phase:

Pre-Surgical Preparation: A Meticulous Approach

Before surgery, meticulous planning ensures optimal outcomes. Rigorous assessments gauge your overall health and identify potential risks. Diagnostic tests, such as echocardiograms and electrocardiograms, provide detailed information about your heart’s condition. The healthcare team meticulously outlines pre-operative preparations, including:

• Fasting instructions for a designated period before surgery.
• Temporary discontinuation of specific medications, following your doctor’s guidance.
• In-depth discussions about anaesthesia options and potential surgical risks.
• Addressing any concerns you or your family may have regarding the procedure.

Surgical Intervention: Repair or Replacement

The surgical approach itself typically involves these steps:

• Anesthesia: General anaesthesia is administered to ensure complete unconsciousness and pain-free surgery.
• Incision: The surgeon creates an incision in the chest to access the heart, employing either traditional open-heart surgery or minimally invasive techniques, depending on your specific case.
• Cardiopulmonary Bypass (CPB): In open-heart surgery, CPB may be utilized to temporarily divert blood flow away from the heart, allowing the surgeon to operate on the valve while maintaining circulation.
• Valve Intervention: If feasible, the surgeon will meticulously repair the aortic valve to restore its functionality. In cases requiring valve replacement, the diseased valve is removed, and a prosthetic valve (either mechanical or biological) is securely implanted in its place.
• Closure: Once the repair or replacement is complete, the surgical team meticulously closes the incision(s) with sutures or surgical staples.

Post-Surgical Care: Recovery and Beyond

Following surgery, you’ll receive comprehensive care, encompassing both hospitalisation and continued monitoring after discharge. This includes:

• Intensive Care: Close monitoring in the intensive care unit (ICU) or a specialized cardiac care unit ensures your well-being.
• Gradual Recovery: As you progress, you’ll be transitioned to a step-down unit or a regular hospital room for continued observation and care before discharge.

Hospital-based care focuses on:

• Preventing infection at the incision sites.
• Closely monitoring vital signs, heart rhythm, and oxygen levels.
• Managing pain to ensure comfort during recovery.
• Implementing mobility exercises and physical therapy to promote circulation and prevent complications.

Post-discharge care involves:

• Continued monitoring of vital signs and overall health.
• Following prescribed dietary guidelines and medication regimens.
• Adhering to activity restrictions and gradually increasing physical activity as advised by your healthcare providers.
• Promptly notifying your healthcare providers of any concerning symptoms or changes in health status.

Benefits of Aortic Valve Surgery

Aortic valve surgery offers a multitude of benefits, potentially extending and enhancing your life:

• Symptom Relief: Surgery can alleviate symptoms like chest pain, shortness of breath, fatigue, and fainting, associated with aortic valve disease.
• Reduced Risk of Complications: By correcting the valve malfunction, surgery can significantly reduce the risk of complications from aortic valve disease, such as heart failure, stroke, and even death.
• Improved Heart Function: A repaired or replaced valve allows your heart to pump blood more efficiently throughout your body, leading to improved overall heart function.
• Enhanced Quality of Life: Many patients who undergo aortic valve surgery report a significant improvement in their quality of life. They are often able to be more active and participate in activities that were previously limited by their condition.

Potential Complications

As with any surgery, aortic valve surgery carries some potential complications. Your healthcare team will discuss these with you in detail before the procedure. Here’s a list of some potential complications:

• Bleeding: Excessive bleeding during or after surgery may necessitate blood transfusions or additional interventions.
• Infection: Surgical site infections or systemic infections can develop, requiring antibiotic treatment and possible surgical intervention.
• Heart Rhythm Abnormalities: Arrhythmias may occur postoperatively, requiring medication or other interventions to regulate heart rhythm.
• Stroke: Dislodgement of blood clots or debris during surgery can lead to stroke or transient ischemic attacks (TIAs).
• Kidney Dysfunction: Impaired kidney function or kidney failure may occur due to reduced blood flow or exposure to contrast agents during surgery.
• Prosthetic Valve Complications: Mechanical valves may require lifelong blood-thinning medication to prevent blood clots, while biological valves have a limited lifespan and may require future replacement.
• Pulmonary Complications: Pneumonia, atelectasis, or respiratory failure can occur due to impaired lung function or postoperative respiratory complications.
• Neurological Complications: Cognitive dysfunction, confusion, or memory impairment may occur as a result of cerebral hypoperfusion or embolic events during surgery.
• Wound Healing Issues: Delayed wound healing, wound dehiscence, or incisional hernias may occur at the surgical site, requiring additional wound care or surgical revision.
• Psychological Impact: Postoperative depression, anxiety, or adjustment disorders may occur as a result of the stress and emotional challenges associated with surgery and recovery.

Frequently Asked Questions

How is aortic valve disease diagnosed?

Aortic valve disease is diagnosed through medical history, physical examination, imaging tests (such as echocardiogram), and sometimes additional tests like cardiac catheterisation or CT angiography.

What are some symptoms of aortic valve disease?

Symptoms of aortic valve disease are chest pain, dizziness, heart palpitations, fatigue, shortness of breath, and fainting. However, some individuals may not experience noticeable symptoms until the condition has progressed.

Are there different types of aortic valve replacements?

Yes, there are two main types of aortic valve replacements: mechanical valves and biological valves. Mechanical valves are made of more durable materials and last longer, but require lifelong blood-thinning medication. Biological valves do not require blood-thinning medication but have a limited lifespan.

How is the choice between mechanical and biological valves made?

The choice between mechanical and biological valves is made based on factors like age, lifestyle, overall health, preference, and the advice of the heart surgeon.

How long does an aortic valve replacement surgery take?

The duration of aortic valve replacement surgery varies depending on the complexity of the case, but it typically takes between 2 to 4 hours.

What is the recovery period after aortic valve replacement surgery?

The recovery period after aortic valve replacement surgery can vary, but most individuals spend a few days in the hospital and require several weeks or months for a full recovery, including rehabilitation and returning to normal activities.

What are the risks and complications associated with aortic valve replacement surgery?

Like any surgery, aortic valve replacement carries risks such as bleeding, infection, blood clots, abnormal heart rhythms, and adverse reactions to anaesthesia. The surgeon will discuss the risks before the procedure.

Can transcatheter aortic valve replacement (TAVR) be an alternative to traditional open-heart surgery?

Yes, transcatheter aortic valve replacement (TAVR) is an alternative, minimally invasive procedure compared to traditional open-heart surgery in select cases, particularly for individuals who are at higher risk for surgery.

Can aortic valve replacement be performed through a minimally invasive approach?

Yes, in certain cases, aortic valve replacement can be performed by a minimally invasive approach, using smaller incisions and specialised surgical techniques. This approach may result in faster recovery and fewer complications.

Can aortic valve replacement be done without removing the entire valve?

In some cases, aortic valve repair techniques may be used to preserve the patient’s own valve tissue instead of complete valve replacement. This approach is determined by the specific condition and the expertise of the surgeon.

Can aortic valve replacement surgery be combined with other cardiac procedures?

Yes, aortic valve replacement surgery can be combined with other cardiac procedures like coronary artery bypass grafting (CABG) or mitral valve repair or replacement, depending on the individual’s needs and the surgeon’s recommendations.

Can I live a normal life after aortic valve replacement?

Yes, with proper post-operative care and adherence to medical advice, many individuals can live a normal and active life following aortic valve replacement. Regular follow-up visits with the cardiac surgeon are important to monitor the valve function.

Will I need to take medication after aortic valve replacement?

After aortic valve replacement, you may need to take medications such as blood thinners (for mechanical valves), medications to control blood pressure or prevent infection, and sometimes medications for heart function support.

Can aortic valve disease recur after replacement surgery?

In general, aortic valve disease does not recur after successful replacement surgery. However, other heart conditions or complications may arise, requiring ongoing monitoring and management.

Can aortic valve replacement be performed in older adults?

Aortic valve replacement can be performed in older adults, and age alone is not a barrier to surgery. The decision depends on the overall health status of the individual and a thorough evaluation by the healthcare team.

Can aortic valve replacement be performed in children or young adults?

Yes, aortic valve replacement can be performed in children and young adults with aortic valve conditions. The timing and type of replacement will be determined by the specific condition and the expertise of the paediatric cardiac surgeon.

Can aortic valve replacement improve quality of life?

Yes, for individuals with symptoms and limitations caused by aortic valve disease, aortic valve replacement can significantly improve quality of life by restoring normal heart function and relieving symptoms.

Can one get pregnant after aortic valve replacement?

Pregnancy after aortic valve replacement is possible, but it requires careful evaluation and counselling by a healthcare team experienced in managing cardiac conditions during pregnancy. Close monitoring throughout pregnancy is necessary.

Can aortic valve replacement affect exercise capacity?

In most cases, aortic valve replacement can improve exercise capacity by correcting the underlying valve disease and improving heart function. It is important to discuss exercise guidelines and limitations with the cardiac surgeon.

Can aortic valve replacement be performed in individuals with other heart conditions?

Aortic valve replacement can be performed in individuals with other heart conditions, but additional heart conditions may affect the overall treatment plan. A comprehensive evaluation by the healthcare team is necessary.

Can aortic valve replacement prevent further damage to the heart?

Yes, aortic valve replacement helps restore normal blood flow and prevents further damage to the heart caused by untreated aortic valve disease, reducing the risk of complications and improving long-term outcomes.

Can aortic valve replacement be performed with minimally invasive techniques in high-risk patients?

Yes, for high-risk patients who are not suitable candidates for traditional open-heart surgery, transcatheter aortic valve replacement (TAVR) is an option that can be considered, depending on individual factors and eligibility criteria.

Can aortic valve replacement be performed if other comorbidities are present?

The decision to perform aortic valve replacement in the presence of other comorbidities depends on the specific conditions, their severity, and the overall health status of the individual. A complete evaluation and discussion with the healthcare team are necessary to determine the best approach.