Aortic valve replacement or aortic valve replacement is an open heart surgery procedure that is performed to treat patients with aortic valve disorders. This procedure aims to replace the aortic valve that has failed or is malfunctioning. Damaged aortic valves are replaced with artificial aortic valves, from synthetic materials or animal body tissues.
The aorta is the largest arterial blood vessel that is directly connected to the heart, and is tasked with flowing oxygen-rich blood from the heart to the entire body. Before entering the aorta, blood from the left ventricle of the heart passes through the aortic valve, which is one of the four valves that the heart has. Aortic valve that is not functioning normally will cause disruption of blood flow, so the heart will work extra to meet the needs of blood supply throughout the body.
Indications for Aortic Valve Replacement
Aortic valve replacement procedure is carried out under the following conditions:
- Aortic valve regurgitation, a condition in which the heart's aortic valve cannot close tightly. This condition causes a portion of the blood supply that is already in the aorta, back again to the left ventricle (ventricle) of the heart. Symptoms of aortic valve regurgitation can include fatigue and shortness of breath (dyspnea) due to disruption of blood supply throughout the body.
- Aortic valve stenosis (aortic stenosis), or narrowing of the aortic valve. This condition causes blood flow from the left ventricle to the aorta to be obstructed, so that blood accumulates not only in the left ventricle, but also in the part of the heart that drains blood into the left ventricle, which is the portico (atrium) Symptoms of aortic valve stenosis in the form of fainting, chest pain (angina ), shortness of breath, palpitations, and fatigue even if only doing light activities.
The doctor's decision to replace the aortic valve is based on a number of factors, such as age, health condition, and the severity of the aortic valve disease. Aortic valve conditions can get worse if not treated immediately. The worst result is heart failure.
There is no medicine that can cure aortic valve disease. Therefore, the procedure for replacing the aortic valve becomes the main action to overcome it.
Aortic Valve Replacement Warning
Patients with aortic valve disease who also have kidney and lung disease need to be careful before undergoing aortic valve replacement surgery.
Preparation for Aortic Valve Replacement
Consult your doctor about the procedure to be undertaken, the risks, or complications that can occur. Before surgery, the doctor will do a physical examination, medical history, especially whether to have an allergy to the anesthetic (anesthesia), as well as blood tests, electrocardiography (ECG), echocardiography, and X-ray examination.
Tell the doctor about the medicine being consumed. The doctor will assess whether or not to stop the drug. Patients need to fast eating and drinking since the night before the operation, and not smoking before the surgical procedure.
Aortic Valve Replacement Procedure
Valve replacement surgery lasts for several hours depending on the patient's condition. The doctor will begin the procedure by administering an anesthetic. Anesthetic will make the patient unconscious and feel no pain during the operation.
After administering the anesthetic, the heart surgeon will make a 25 cm long incision in the middle of the sternum, or it can also make a small incision to open the heart area. A tube or catheter will be connected between the heart, large bottom vessels, and machines that replace the heart's work. During surgery, the heart will stop beating.
After that, the doctor will give medicines that can stop the heart's work. This condition allows the doctor to perform surgery on the heart.
The doctor will remove the damaged aorta when the valve is open. Old aortic valves are replaced by new aortic valves by stitching using fine threads. The valve used can be:
- Artificial mechanical valve.
- Valves made from animal body tissue (bioprosthesis), such as cattle or pigs, or tissue taken from the human heart (homograft).
About 80 percent of patients use aortic valve bioprosthesis. This network is believed to be safer and durable for up to 15-20 years.
After stitching, heart function will be restored to normal with the help of an electric shock device. The heart bypass device is then removed. Next, the sternum will be reconnected with wires. Surgical scars on the chest will be closed with a number of stitches.
The valve calling method can also be done without an incision. This procedure is called a transcatheter aortic valve replacement (TAVR) or also called a transcatheter aortic valve implantation (TAVI).
The doctor will open the heart through a vein in the leg or make a small incision in the chest. The tube is connected through a vein to the aortic valve. After that, a new aortic valve is installed.
The doctor will perform a TAVR procedure if the patient:
- Have a moderate to high level of risk for complications after surgery.
- Never replace the aortic valve with biological tissue.
After Aortic Valve Replacement
The valve replacement patient will wake up a few hours after the operation. When you wake up for the first time, patients will usually feel confused. The condition can gradually improve after resting in the recovery room.
The doctor will monitor the patient's vital signs, such as heart rate and lung function. The doctor will give painkillers when the anesthetic effect has been used up. The breathing tube connection is fixed until the patient can breathe normally.
Then, the patient is transferred to the intensive care unit (intensive care unit / ICU). Other actions that can be taken at ICU include:
- Installation of pacemakers to control heart rate.
- Fluid flow in the chest to remove the buildup of fluid and blood in the chest cavity.
- Use of urine catheter.
- Cable attachment connected to sensor pads to measure heart rate, blood pressure, and oxygen flow in the blood.
- Provision of food or drink intake to increase appetite and improve health conditions.
Ask your family or close relatives to take you home. You still need their help when doing activities at home. Consult your doctor about actions that should not be done after undergoing aortic valve replacement procedure.
Complications of Aortic Valve Replacement
Poor health and the elderly at risk of complications after undergoing aortic valve replacement surgery. These complications include:
- Infection in the surgical wound, bladder, lungs or heart valves, and antibiotics can be given to reduce the risk of infection.
- Excessive bleeding.
- Heart rate disorder or arrhythmia.
- Transient ischemic attack (TIA), which is the temporary obstruction of blood supply to the brain.
- Dead.
