Aortic valve replacement

Overview

• Definition: Surgical procedure to replace a dysfunctional aortic valve with a prosthetic valve.

Indications

• Aortic Stenosis: Most common indication. Symptoms or significant obstruction.
• Aortic Regurgitation: Symptoms or LV dysfunction.
• Endocarditis: When not amenable to medical treatment or causing severe valvular damage.
• Valve damage due to rheumatic heart disease.

Types of Prosthetic Valves

• Mechanical Valves: Durable, but require lifelong anticoagulation (e.g., warfarin).
• Bioprosthetic Valves (Tissue Valves): Derived from pig or cow tissue or human cadavers. Less durable but don’t require long-term anticoagulation.

Procedure

• Usually performed via median sternotomy with cardiopulmonary bypass.
• Defective valve is excised, and prosthetic valve is sutured into place.
• Emerging techniques include Transcatheter Aortic Valve Replacement (TAVR) for high-risk surgical patients.

Complications

• Immediate: Bleeding, arrhythmias, myocardial infarction, stroke.
• Long-term: Prosthetic valve dysfunction, thromboembolism, endocarditis, anticoagulation-related bleeding (for mechanical valves).

Post-operative Care

• Monitoring in an intensive care setting initially.
• Regular ECG and echocardiographic evaluations.
• Anticoagulation management, especially with mechanical valves.
• Prophylaxis for infective endocarditis during certain medical and dental procedures.

Prognosis

• Significantly improves symptoms and survival especially in symptomatic severe aortic stenosis.
• Regular follow-up essential to monitor for complications and ensure optimal functioning of the prosthetic valve.

Key Points

• Choice between mechanical and bioprosthetic valve depends on patient’s age, comorbidities, and preference.
• TAVR offers a less invasive option for those unsuitable for open surgery.
• Patients with mechanical valves require careful anticoagulation management.