More About Aortic Valve Replacement

An aortic valve replacement is a type of open heart surgery used to treat problems with the heart's aortic valve. It involves removing a faulty or damaged valve and replacing it

Diagnosis for aortic valve replacement surgery

• Aortic stenosis - when  the opening of the valve becomes smaller, obstructing the flow of blood out of the heart

• Aortic regurgitation - when the valve is leaky  allowing  blood to flow back through into the heart .

Signs of heart failure requiring valve replacement

• shortness of breath

• Angina

• Dizziness

• Fainting

• Swelling of ankles , feet and legs

• Fatigue

Physical Exam

• With stethoscope to check for heart murmur caused by a heart valve problem.

• Your doctor will check for fluid  in lungs

• check for swollen ankles and other signs for water retention .

Diagnostic Tests

• Echocardiography (echo) is the main test for diagnosing heart valve disease .

• Transesophageal echo, or TEE, to get a better image of your heart

• ECG (electrocardiogram) to diagnose irregular heart beat and signs of previous heart attack

• Chest x ray- to see if heart enlarged or fluid in lung or calcium deposists in heart.

• cardiac catheterization, stress testing, or cardiac MRI help your doctor assess how severe your condition is so he or she can plan your treatment.

Types of  Aortic Valve Surgery  

• Open Aortic valve replacement via sternotomy – wherein damaged aortic valve is replaced by surgery
• Transcatheter aortic valve implantation (TAVI) – the replacement valve is guided into place through the blood vessels, rather than through a large incision in the chest
• Minimally invasive cardiac surgery (MICS) -

Procedure for Aortic Valve Replacement

Before procedure

• Standard blood and  tests and  performed to check fitness for surgery .

• Patient counselled  about the procedure and after care

During Procedure(open surgery )

• Procedure performed under general anaesthesia

• IV  line inserted , breathing tube is inserted and catheter put in bladder

• Incision  made in middle  of chest ,surgeon  separates sternum to expose pericardium ,then  opens pericardium to expose heart

• Connects heart  to heart lung machine , tubes are used to reroute the blood into machine which takes over the function of heart and lung during the operation

• Heart is temporarily stopped and blood removed , aortic valve is still and allows surgeon to see it .

• Surgeon opens aorta to see aortic valve , makes incision around edge of damaged  valve and replaces it .

• The surgeon then closes the aorta with stitches , blood allowed to flow into heart to check the function of heart , if needed electric shock given to heart to restart the heart .

• Temporary pacemaker wires on surface to ensure normal rhythm of heart

After Procedure

After an aortic valve replacement, you'll usually need to stay in hospital for about a week.

You will be kept in intensive care unit (ICU) for the first day or two after your operation, before moving to a surgical ward.

• the activity of your heart, lungs and bodily functions will be closely monitored , wires attached to sensor pads to measure your heart rate, blood pressure and blood flow, and the air flow to your lungs

• you'll be given painkillers

• a tube attached to a ventilator will be placed until you're able to breathe

• You may have several tubes and monitors attached to you ,

•  Draining tube  – small tubes from your chest to drain away any build-up of blood or fluid

• Pacing wires – if necessary, these will be inserted near the chest drains to control your heart rate

After care

• Adviced to follow a cardiac rehabilitation programme

• avoid strenuous exercise, sudden strains and heavy lifting for three months

• you may not be able to drive for around six weeks

• report to the physician if signs of infection

Risks of Aortic Valve Replacement surgery

The aortic valve replacement is a major surgery and like any other surgery carries risks , the risks of complications increase with the age of the patient and general health of patient

• Infection – there's a risk of wound infections, lung infections, bladder infections and heart valve infections

• Excessive bleeding

• Blood clots

• Stroke

• The valve may wear out

• Temporary arrhythmia (iregular heartbeat )

• Kidney problems for few days after surgery – In a few cases, temporary dialysis may be needed.

• A valve that fails- There is a small chance that the valve will not work.

Factors Affecting Cost Of Aortic valve Replacement

The cost to the patient depends on a variety of factors like

• The hospital, the patient chooses.
• Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
• Fee for the team of doctors and OT charges
• cost of  medications
• Standard test and diagnostic procedures.
• cost of the valve selected
• Cost of the follow –up care required after the procedure