Aortic valve replacement is a procedure in which surgery is used
to repair or replace a diseased aortic heart valve.
There are
4 valves in the heart: the Aortic, Mitral, Tricuspid and the Pulmonary valves.
These valves are designed to control the direction of blood flow through the
heart. The opening and closing of the heart valves produce the sound of the heartbeat.
Aortic valve replacement is open-heart surgery that is done while
the patient is under general anesthesia. An incision is made through the breast
bone (sternum). Tubes are used to re-route the blood away from the heart to a
heart-lung bypass machine to keep the blood oxygenated and circulating while
the heart is being operated on.
Heart valve replacement is a surgical procedure
during which surgeons remove a damaged valve from the heart and substitute a
healthy one.
Purpose
Four valves direct blood to and from the body through the heart:
the aortic valve, the pulmonic valve, the tricuspid valve, and the mitral
valve. Any of these valves may malfunction because of a birth defect,
infection, disease, or trauma. When the malfunction is so severe that it
interferes with blood flow, an individual will have heart palpitations,
fainting spells, and/or difficulty breathing. These symptoms will progressively
worsen and cause death unless the damaged valve is replaced surgically.
Abnormal tricuspid valves usually are not replaced because they do
not cause serious symptoms. Mildly or even moderately diseased mitral valves
may not need to be replaced because their symptoms are tolerable or they can be
treated with such drugs as beta blockers or calcium antagonists, which slow the
heart rate. However, a severely diseased mitral valve should be repaired or
replaced unless the person is too ill to tolerate the operation because of
another condition or illness.
After cutting through and separating the breastbone and ribs,
surgeons place the patient on a cardiopulmonary bypass machine, which will
perform the functions of the heart and lungs during the operation. They then
open the heart and locate the faulty valve. Slicing around the edges of the
valve, they loosen it from the tendons that connect it to the rest of the heart
and withdraw it. The new valve is inserted and sutured into place. The patient
is then taken off the bypass machine and the chest is closed. The surgery takes
three to five hours and is covered by most insurance plans.
A patient usually spends one to three days in the hospital
intensive care unit (ICU) after heart valve replacement so that the working of
his or her heart and circulation can be monitored closely. When first brought
to the ICU after surgery, the patient undergoes a neurological examination to
be sure he or she has not suffered a stroke. The patient continues to breathe
by means of a tube inserted in the trachea at the time of surgery. This
mechanical ventilation is not withdrawn until the patient is fully awake from
anesthesia, shows signs that he or she can breathe satisfactorily without
mechanical support, and has steadfast circulation.
Once stablilized, the patient is transferred to a standard
medical/surgical unit where he or she receives drugs that will prevent excess
fluid from building up around the heart. As soon as possible, the patient
begins walking and exercising to regain strength. He or she is also placed on a
diet that is low in salt and cholesterol.
Complications following heart valve replacement are not common,
but can be serious. All valves made from animal tissue will develop calcium
deposits over time. If these deposits hamper the function of the valve, it must
be replaced. Valves may become dislodged. Blood clots may form on the surface
of the substitute valve, break off into the general circulation, and become
wedged in an artery supplying blood to the brain, kidneys, or legs. These blood
clots may cause fainting spells, stroke, kidney failure, or loss of circulation
to the legs. These blood clots can be treated with drugs or surgery.
There are three types of replacement valves. One
class is made from animal tissue, usually a pig's aortic valve. Another is
mechanical and is made of metal and plastic. The third, includes human valves
that have been removed from an organ donor or that, rarely, are the patient's
own pulmonic valve.
There is no single ideal replacement valve. The choice between an
animal valve or a mechanical valve depends largely on the age of the patient. Because
valves obtained from animals have a life expectancy of 7-15 years, they usually
are given to older patients. Mechanical valves are used in younger patients
because they are more durable. Because mechanical valves are made of foreign
material, however, blood clots can form on their surface. Therefore, patients
who receive these valves must take anticoagulants for the rest of their lives.
Donor or pulmonic valves are given only to those patients who will
deteriorate rapidly because of a narrowing of the passageway between the aorta
and the left ventrical (aortic stenosis). These valves are limited in their use
because of the small supply available from donors and the strain that could be
caused by removing and transferring a patient's own pulmonic valve.
The most advanced technology for minimally invasive heart surgery is now available in
India. Robotic da Vinci Surgical System combines superior 3D visualization along with greatly
enhanced dexterity, precision and control in an intuitive, ergonomic interface with
breakthrough surgical capabilities.In Robotic Cardiac Surgery, robotic assist the heart
surgeon in performing surgery through tiny incisions. The surgeon has to sit in an operating
room where he controls the instruments while looking at 3D images from the camera which
is inside the patient.
Various procedures can be performed in this case such as mitral valve replacement or repair,
correction of HOCM etc. Use of Robotic Surgery in Cardiology has benefits as it involves
less pain, scarring and risk that are otherwise involved. The surgeon can perform surgery
through tiny openings in the chest, cracking the breastbone and spreading the ribs.
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