Aortic valve replacement is a surgical procedure used to repair dangerous malfunctions in the heart's largest valve. The most common reason for aortic replacement in the U.S. is stenosis, or failure of the valve to open or close properly. Techniques for valve surgery include mechanical replacement, biological replacement and a newer technique called the Ross procedure.
Determining Suitability for Treatment
You are a potential candidate for aortic valve replacement if you have stenosis, or if an improper seal in the closed aortic valve allows blood to leak back into the heart. Both of these conditions can lead to excessive strain on the heart, and if left untreated may result in heart failure or cardiac arrest. If you are physically able to withstand the stresses of surgery, valve replacement is the preferred method of treatment.
Mechanical Replacement
The particular type of replacement surgery chosen will depend on the particulars of your condition and the preference of your cardiologist (heart specialist) and cardiothoracic surgeon. If durability of the replacement valve is a main concern, you may undergo mechanical replacement. In this procedure, your surgeon will remove your damaged aortic valve and replace it with a man-made substitute. Numerous types of mechanical replacements exist, and they are put in place in a number of different ways, but their overall function is essentially the same. Most importantly, they do not wear out over a human lifetime, so you will only have to receive a single replacement valve.
The most common dangerous side effect of mechanical replacement is the formation of blood clots on the surface of the valve. To avoid this possibility, you will generally take a blood thinner such as warfarin (Coumadin) for the rest of your life. Even with this treatment, your risk for stroke will increase.
Biological Replacement
Biological valve replacement comes with a much lower risk of blood clot complications, but they are also far less durable. If you undergo this form of treatment, your surgeon will replace your damaged aortic valve with a valve obtained from a pig or cow---called a xenograft---or from a human donor. Due to factors including the pressure exerted on these biological replacements by the heavy flow of blood to the aorta, their effective lifespan is limited. If you receive a biological replacement past the age of 40, it will typically last 15 years or so without losing function. If you are younger, the valve will degrade at a faster pace.
The Ross Procedure
If you are 50 or younger, you may be a candidate for a newer replacement technique called the Ross procedure. In this method, your faulty aortic valve is replaced with your own pulmonary valve, which controls blood flow to the lungs. As a secondary procedure, your pulmonary valve is replaced with another pulmonary valve from a human donor. Over time, your aortic replacement grows in strength, and the procedure can be a long-term solution. In roughly 10 percent of cases, leakage occurs as a side effect in the repaired aortic valve.
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