How is aortic valve disease treated?

If you do not have symptoms or heart damage, you will need to protect your valve from further damage by following precautions to reduce the risk of infective endocarditis, and you may need to take medications. In addition, surgery may be needed to treat your condition if you have symptoms, evidence of heart damage, or heart failure.

Aortic valve surgery

There are two types of aortic valve surgery: aortic valve repair and aortic valve replacement.

During aortic valve surgery, including aorta surgery, the aortic valve may be repaired or replaced. The results of your diagnostic tests, the structure of your heart, your age, the presence of other medical conditions and other factors will be considered to determine whether aortic valve repair or replacement is the best treatment approach for you.

Aortic valve surgery can be performed using traditional heart valve surgery or minimally invasive approaches.

Traditional Aortic Valve Surgery

During traditional aortic valve surgery, a surgeon makes a 6- to 8-inch incision down the center of your sternum, and part or all of the sternum (breastbone) is divided to provide direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.

Minimally Invasive Aortic Valve Surgery

Minimally invasive aortic valve surgery is a type of aortic valve repair surgery performed through smaller, 2- to 4-inch incisions without opening your whole chest. This is typically done with a ā€œJā€ incision and leaves your chest stable. Minimally invasive surgery reduces blood loss, trauma, length of hospital stay and may accelerate recovery.

Most patients who require isolated aortic valve surgery are candidates for minimally invasive aortic valve surgery, but your surgeon will review your diagnostic tests and determine if you are a candidate for this type of surgery.

Aortic valve repair

While the aortic valve is usually replaced, aortic valve repair may be an option.

Bicuspid aortic valve repair

Bicuspid aortic valve repair

A bicuspid aortic valve may be repaired by reshaping the aortic valve leaflets allowing the valve to open and close more completely.

Bicuspid aortic valve repair may be an option to treat leaking valves, but it can not be used to treat a stenotic or narrowed bicuspid aortic valve.

Bicuspid aortic valve repair can be performed using a minimally invasive ā€œJā€ incision surgical technique. The aortic valve surgery is technically difficult and should be performed by a surgeon with experience repairing aortic valves.

Repair of an enlarged aorta

Aortic valve disease is often associated with enlargement (aneurysm) of the ascending aorta, the initial portion of the aorta (the main blood vessel in the body that originates from the aortic valve).

If the enlargement of the aorta is substantial (usually above 4.5 or 5 cm in diameter), this part of the aorta may need to be replaced. The replacement is done at the time of aortic valve repair or replacement. In patients who have leaky aortic valve and an enlarged aorta, a special procedure (David procedure) can be performed. The David procedure allows surgeons to repair the aortic valve and simultaneously replace the enlarged ascending aorta.

Repair of valve tears or holes

In addition, if the valve leaflets have tears or holes, the surgeon can patch these with tissue patches.

Aortic valve replacement

If valve repair is not an option, your surgeon may replace the valve. The native (original) valve is removed and a new valve is sewn to the annulus of your native valve. The new valve can either be mechanical or biological.

Biological valve replacement

Biological Valve Replacement

At Cleveland Clinic, the majority of aortic valves are replaced with a bioprosthesis. Biological valves (also called tissue or bioprosthetic valves) are made of tissue, but they may also have some artificial parts to provide additional support and allow the valve to be sewn in place.

About 80% of aortic valves are replaced with a bioprosthesis.

Biological valves can be made from pig tissue (porcine), cow tissue pericardial (bovine), or pericardial tissue from other species.

These valves are safe to insert, durable (lasting from 15 to 20 years), and allow patients to avoid lifetime use of anticoagulants (blood thinning medications). At the Cleveland Clinic the risk of death is less than one percent for isolated aortic valve replacement and has consistently been better than predicted mortality based on the Society of Thoracic Surgeons (STS) national data.

Human Homograft (also called allograft) aortic valve replacement

Aortic Homograft

A homograft is an aortic or pulmonic valve that has been removed from a donated human heart, preserved, treated with antibiotics, and frozen under sterile conditions.

Homografts are used especially when the aortic root is destroyed by endocarditis (infection).

Mechanical valves replacement

Mechanical Valves Replacement

Mechanical valves are made completely of mechanical parts, which are non-reactive and tolerated well by the body. The bileaflet valve is used most often.

It consists of two pyrolite (qualities similar to a diamond) carbon leaflets in a ring covered with polyester knit fabric.

All patients with mechanical valve prostheses need to take an anticoagulant medication, warfarin (Coumadin), for the rest of their life to reduce the risk of blood clotting and stroke. This increases the risk of bleeding.

Ross Procedure (also called Switch Procedure)

The Ross operation is usually performed on patients under age 30 who want to avoid lifetime use of anticoagulants (blood thinning medications) after surgery.

During this procedure, the patient's normal pulmonary valve is removed and used to replace the diseased aortic valve. The pulmonary valve is then replaced with a pulmonary homograft. The Ross procedure leaves two valves at potential risk of later failure.

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