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Aortic Valve Replacement
An Aaortic Valve Replacement is a type of open-heart surgery used to treat problems with the heart's aortic valve. It involves removing a faulty or damaged valve and replacing it. During this surgery, the damaged valve is removed and replaced with an artificial valve. The valve replacement is mostly an open-heart surgery, in few cases a minimally invasive surgery or a catheter procedure may be possible.
- Aortic stenosis- when the opening of the valve becomes smaller, obstructing the flow of blood out of the heart.
- Aortic regurgitation- when the valve is leaky allowing blood to flow back through into the heart .
Signs of Heart Failure requiring Replacement
- shortness of breath
- Swelling of ankles, feet and legs
- With stethoscope to check for heart murmur caused by a heart valve problem.
- Your doctor will check for fluid in lungs.
- check for swollen ankles and other signs for water retention.
- Echocardiography (echo) is the main test for diagnosing heart valve disease.
- Transesophageal Echo or TEE, to get a better image of your heart.
- ECG (electrocardiogram) to diagnose irregular heart beat and signs of previous heart attack.
- Chest X ray- to see if heart enlarged or fluid in lung or calcium deposists in heart.
- Cardiac Catheterization, Stress Testing or Cardiac MRI help your doctor assess how severe your condition is so he or she can plan your treatment.
Types of Aortic Valve Surgery
- Open Aortic Valve Replacement via Sternotomy– wherein damaged aortic valve is replaced by surgery.
- Transcatheter Aortic Valve Implantation (TAVI)– the replacement valve is guided into place through the blood vessels, rather than through a large incision in the chest.
- Minimally Invasive Cardiac Surgery (MICS)
Procedure for Aortic Valve Replacement
- Standard blood and tests and performed to check fitness for surgery.
- Patient counselled about the procedure and after care.
- Procedure performed under general anaesthesia.
- IV line inserted, breathing tube is inserted and catheter put in bladder.
- Incision made in middle of chest, surgeon separates sternum to expose pericardium, then opens pericardium to expose heart.
- Connects heart to heart lung machine, tubes are used to reroute the blood into machine which takes over the function of heart and lung during the operation.
- Heart is temporarily stopped and blood removed, aortic valve is still and allows surgeon to see it.
- Surgeon opens aorta to see aortic valve, makes incision around edge of damaged valve and replaces it.
- The surgeon then closes the aorta with stitches, blood allowed to flow into heart to check the function of heart, if needed electric shock given to heart to restart the heart.
- Temporary pacemaker wires on surface to ensure normal rhythm of heart.
- After an aortic valve replacement, you'll usually need to stay in hospital for about a week.
- You will be kept in intensive care unit (ICU) for the first day or two after your operation, before moving to a surgical ward.
- the activity of your heart, lungs and bodily functions will be closely monitored, wires attached to sensor pads to measure your heart rate, blood pressure and blood flow, and the air flow to your lungs.
- you'll be given painkillers.
- a tube attached to a ventilator will be placed until you're able to breathe.
- You may have several tubes and monitors attached to you.
- Draining tube – small tubes from your chest to drain away any build-up of blood or fluid.
- Pacing wires– if necessary, these will be inserted near the chest drains to control your heart rate.
- Adviced to follow a cardiac rehabilitation programme
- avoid strenuous exercise, sudden strains and heavy lifting for three months
- you may not be able to drive for around six weeks
- report to the physician if signs of infection
Risks of Aortic Valve Replacement Surgery
The aortic valve replacement is a major surgery and like any other surgery carries risks. The risks of complications increase with the age of the patient and general health of patient.
- Infection– there's a risk of wound infections, lung infections, bladder infections and heart valve infections
- Excessive bleeding
- Blood clots
- The valve may wear out
- Temporary arrhythmia (iregular heartbeat)
- Kidney problems for few days after surgery– In a few cases, temporary dialysis may be needed.
- A valve that fails- There is a small chance that the valve will not work.
Factors Affecting Cost Of Aortic Valve Replacement
The cost to the patient depends on a variety of factors like:
- The hospital, the patient chooses
- Room– Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service)
- Fee for the team of doctors and OT charges
- cost of medications
- Standard test and diagnostic procedures.
- cost of the valve selected
- Cost of the follow –up care required after the procedure