The Aortic valve is the valve that is placed between the left ventricle ( the main pumping chamber of the heart) and the Aorta( the blood pipe that takes good blood from the heart to the rest of the body). This valve is prone to various types of diseases. In some cases it can be repaired whilst in some cases its too far damaged and has to be replaced.
This can be done through a standard traditional incision which is 20-25cms long or through a mini approach. Herein we will describe the mini approach which is the standard approach for us.
The length of the incision is 5-7cms and is placed in the upper part of the chest . The chest bone or the sternum is also divided for a short distance in the upper half. The aortic valve is easily accessed through his approach and can be repaired or replaced. The advantages of this procedure is less pain, less infection and less bleeding. The recovery is commendably fast and patient stays for an average 3-4 days in the hospital and can get back to work in less than two weeks. He can drive in three to eight weeks.
Aortic valve replacement can also be done by a small 5 cm anterior thoracotomy wherein a small portion of your 3rd and 4th ribs are divided and the valve accessed through this small incision. There is no major advantage for either procedure and both lead to speedy recovery with almost no infection infection rate.
The aortic valve may also get diseased in the young adults or children. In this age group if one can repair the valve and by a few precious years of symptom free life it is of great boon to the patients. The disease that commonly occur in the young that can be repaired are due to Bicuspid aortic valve and sometimes early pick up of rheumatic heart disease.
In bicuspid aortic valve disease the valve can be repaired by bringing it back to a tricuspid configuration which is the normal configuration and resuspending it back in the aortic annulus. Sometimes it may not be the valve that’s is at fault and the annulus that supports it may be the culprit causing a leak due to dilatation of the aorta or the annulus in which case we can do a valve sparing procedure known after a Canadian surgeon from Toronto Dr. Tirone David as “ David procedure”. Here the native valve is retained and the aorta is replaced with a synthetic tube into which the native valve is resuspended. This is a technically challenging operation with good results if done well. The advantages are we retain the natural valve and avoid any blood thinners.
In small children where the valve is very badly diseased and cannot be repaired the choice of valve is difficult. Mechanical valves have good life but require anticoagulation and don’t grow with the child which means the child requires a second operation for sure. The “Ross Procedure” is an operation where we take the pulmonary valve of the child and use it to replace the diseased aortic valve. The advantage being this is natural tissue and will grow with the child. The pulmonary outflow tract that is vacant is instead filled with a Homograft or human tissue that is frozen and specially preserved. This system being a low pressure system the graft deteriorates slowly. The indications of this operation are children or young adults with aortic valve disease not amenable to repair and with small aortic roots. It is done at specialized centers with good short and medium term results, long term results are not encouraging. The risk at reoperation is much more than a reoperation for a second aortic valve replacement.
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