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Aortic valve replacement

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

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