Aortic regurgitation surgery overview
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Aortic Insufficiency Surgery | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:Mohammed A. Sbeih, M.D.[2]; Usama Talib, BSc, MD [3] Related Key Words and Synonyms: Aortic valve replacement.
Overview
Aortic valve replacement is indicated in patients with severe aortic insufficiency who are either symptomatic or those who have a left ventricular end-diastolic diameter >55 mm or 25 mm/m2 or an left ventricular ejection fraction <55%.
The majority of patients with severe aortic regurgitation requiring surgery undergo aortic valve replacement instead of aortic valve repair which is sometimes preformed at highly specialized surgical centers which have appropriate technical expertise and experience in selecting potential patients.[1]
Advanatges of A Mechanical Valve
Mechanical valves are made of man-made (synthetic) materials, such as a metal like titanium. Mechanical heart valves do not fail often. They last from 12 to 20 years. [2][3] However, blood clots develop on them. If a blood clot forms, the patient may have a stroke. Anticoagulation with warfarin will be required which can be associated with bleeding.
Advantages of A Bioprosthetic Valve
Bioprosthetic valves are made of human or animal tissue. Biological valves do not require anticoagulation, but they tend to fail over time.[3][4]Patients with a biological valve may need to have the valve replaced in 10 to 15 years.
Selecting A Mechanical Verssus a Bioprosthetic Valve
The 2006 American College of Cardiology/American Heart Association (ACC/AHA) recommendations for the choice of aortic valve [5][6]:
- If the patient is under 65 years of age and does not have a contraindication to anticoagulation then a mechanical valve is preferred.
- If the patient is ≥65 years of age and does not have risk factors for thromboembolism, then a bioprosthetic valve is reasonable
- If the patient already has a mechanical valve in the mitral or tricuspid position and already requires anticoagulation, then a mechical valve is preferred
- If the patient has active prosthetic valve endocarditis, then the valve should be replaced
- If the patient has contraindications to anticoagulation therapy regardless his or her age, then a bioprosthetic valve is indicated
Operative Mortality
The risk of death or serious complications from isolated aortic valve replacement is typically between 1-3%, depending on the health and age of the patient, as well as the skill of the surgeon and the health care institute. The patient's past history of heart surgery affects the mortality rate as well.
References
- ↑ Miller JG, Li M, Mazilu D, Hunt T, Horvath KA (2016). "Robot-assisted real-time magnetic resonance image-guided transcatheter aortic valve replacement". J Thorac Cardiovasc Surg. 151 (5): 1407–12. doi:10.1016/j.jtcvs.2015.11.047. PMC 4834269. PMID 26778373.
- ↑ Bloomfield P, Wheatley DJ, Prescott RJ, Miller HC (1991). "Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses". N Engl J Med. 324 (9): 573–9. doi:10.1056/NEJM199102283240901. PMID 1992318.
- ↑ 3.0 3.1 Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH (2000). "Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial". J Am Coll Cardiol. 36 (4): 1152–8. PMID 11028464.
- ↑ Hammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S (1993). "A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease". N Engl J Med. 328 (18): 1289–96. doi:10.1056/NEJM199305063281801. PMID 8469251.
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.
- ↑ Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G; et al. (2007). "Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology". Eur Heart J. 28 (2): 230–68. doi:10.1093/eurheartj/ehl428. PMID 17259184.