Aortic valve surgery - minimally invasive (patient information)
Template:Aortic valve surgery - minimally invasive (patient information)
For the WikiDoc page for aortic stenosis surgery, click here; For the WikiDoc page for Aortic regurgitation surgery, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Mohammed A. Sbeih, M.D. [2]
Overview
Aortic valve surgery is done to replace the aortic valve in your heart.
Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.
- An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.
- An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.
Minimally invasive aortic valve surgery is done through much smaller cuts than the large cut needed for open aortic valve surgery.
How is Aortic valve surgery (minimally invasive) done?
Before your surgery you will receive general anesthesia. This will make you fall into a pain-free sleep.
There are several different ways to do minimally invasive aortic valve surgery. Techniques include laparoscopy or endoscopy, robot-assisted surgery, and percutaneous surgery.
- Your surgeon may make a 2-inch to 3-inch cut in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided. This allows the surgeon to reach your heart and aortic valve.
- For the endoscopic, or keyhole, approach, your surgeon makes one to four small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
- For robotically-assisted valve surgery, the surgeon makes two to four tiny cuts (about 1/2 to 3/4 inches) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a three-dimensional view of the heart and aortic valve on the computer. This method is very precise.
You will need to be on a heart-lung machine for all of these surgeries.
If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:
- Mechanical: Made of man-made materials, such as titanium or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
- Biological: made of human or animal tissue. These valves last 10 to 12 years, but you may not need to take blood thinners for life.
In some cases, you will have coronary artery bypass surgery, or surgery to replace the first part of the aorta (large blood vessel leaving the heart) at the same time.
Once the new valve is working, your surgeon will:
- Close the small cut to your heart or aorta
- Place catheters (flexible tubes) around your heart to drain fluids that build up
- Close the surgical cut in your muscles and skin
- The surgery may take 3 to 6 hours.
Aortic valve surgery can also be done through a groin artery. No cuts are made on your chest. The doctor sends a catheter (tube) with a balloon attached on the end to the valve. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.
Who needs Aortic valve surgery (minimally invasive)?
Where to find centers that perform Aortic valve surgery (minimally invasive)?
Directions to Hospitals Performing Aortic valve surgery - minimally invasive
What are the risks of Aortic valve surgery (minimally invasive)?
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs.
- Blood loss.
- Breathing problems.
- Infection, including in the lungs, kidneys, bladder, chest, or heart valves.
- Reactions to medicines.
Minimally invasive surgery techniques have far fewer risks than open surgery. Possible risks from minimally invasive valve surgery are:
- Damage to other organs, nerves, or bones.
- Heart attack, stroke, or death.
- Infection of the new valve.
- Irregular heartbeat that must be treated with medicines or a pacemaker.
- Kidney failure.
- Poor healing of the wounds.
What to expect before Aortic valve surgery (minimally invasive)?
Always tell your doctor or nurse:
- If you are or could be pregnant
- What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.
For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.
- Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
- If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.
Prepare your house for when you get home from the hospital.
The day before your surgery. Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest two or three times with this soap. You also may be asked to take an antibiotic to guard against infection.
During the days before your surgery:
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you smoke, you must stop. Ask your doctor for help.
- Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.
On the day of the surgery:
- You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
- Take the drugs your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
What to expect after Aortic valve surgery (minimally invasive)?
Expect to spend 3 - 5 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).
Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 - 3 days after surgery. You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in a vein) lines to get fluids.
You will go from the ICU to a regular hospital room. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine for pain in your chest.
Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.
A temporary pacemaker may be placed in your heart if your heart rate becomes too slow after surgery.
Results
Mechanical heart valves do not fail often. However, blood clots can develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.
Biological valves tend to fail over time, but they have a lower risk of blood clots.
The results of Aortic valve repair are excellent. To get the best treatment, go to a center that regularly performs this type of surgery.
Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most patients, and they reduce recovery time and pain.