Aortic stenosis surgery overview
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Aortic stenosis surgery | |
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Aortic stenosis surgery overview On the Web | |
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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]; Claudia P. Hochberg, M.D. [3]; Abdul-Rahman Arabi, M.D. [4]; Keri Shafer, M.D. [5]; Priyamvada Singh, MBBS [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]
Overview
Surgical intervention may be a necessary component of treatment for symptomatic severe aortic stenosis. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis, as it improves both the symptoms and life expectancy in aortic stenosis patients, in contrast to medical therapy alone which may improve the symptoms without prolonging life expectancy.
Intervention methods may include:
- Aortic valve replacement, mechanical and device based therapies such as bileaflet mechanical aortic valves.
- Aortic Balloon Valvotomy, aortic valvuloplasty (aortic valve repair).
Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure. It can be performed emergently in patients with end-stage heart failure due to aortic stenosis, patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis. Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina.
In open surgery, the surgeon makes a large cut in the sternum to reach the heart.
Minimally invasive aortic valve surgery is done through much smaller surgical cuts than the large cuts needed for open surgery.
Epidemiology and Demographics
The number of patients undergoing aortic valve replacement surgery to treat aortic stenosis has increased progressively over the past 10 years. The surgery is usually performed in elderly patients with preserved ejection fractions. Transcatheter aortic valve implantation (TAVI) represents a new option in patients with no surgical options.
Indications
Aortic stenosis requires aortic valve replacement if medical management does not successfully control symptoms. According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed [1].
References
- ↑ Grube E, Laborde JC, Gerckens U; et al. (2006). "Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study". Circulation. 114 (15): 1616–24. doi:10.1161/CIRCULATIONAHA.106.639450. PMID 17015786.