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When patients are faced with the diagnosis of severe aortic valve disease, it is very difficult to sort out their best options. It is often a highly emotional and confusing time. This article will guide prospective patients through the necessary steps to get good information about the best aortic valve operation and find the right heart surgeon to fit their needs.
A few words about these aortic valve conditions:
Aortic Stenosis means that the aortic valve is severely calcified and stiff. It cannot open wide when it is supposed to. A normal aortic valve has three flimsy and extremely pliable leaflets (cusps) that will open and allow unimpeded flow through a roughly circular cross-section with a diameter of about one inch. A severely stenotic valve only allows flow through a pinhole. That explains that hissing sound that doctors refer to as a 'murmur'. The heart eventually tires out and immediate surgery is necessary before it gets to that point.
Aortic Insufficiency or Regurgitation consists somewhat of the opposite situation. The valve is stretched out or 'frozen' in an open position and cannot close when it is supposed to. That's what it is commonly referred to as a leaky valve. The heart struggles to maintain a forward flow because some of the oxygenated blood leaks backwards. It eventually enlarges and becomes progressively weaker. Again, surgery is necessary before it loses its strength.
Do not fool yourselves. There is no effective medical therapy for severe symptomatic aortic valve disease. It is a mechanical problem that requires a prompt mechanical solution. It requires one of two main surgical treatments:
Aortic valve replacement with a mechanical, a biological prosthetic valve or an autograft
Aortic valve repair, mostly in aortic insufficiency cases
Ross procedure in selected cases
Most advanced minimally invasive heart surgery centers can carry out these procedures through a 2' incision on the right side of the chest between the ribs. This approach does not involve any bone cutting and it is followed by a quick recovery and wound healing with very little pain or bleeding. Most patients can return to their homes and families within two or three days even if they are elderly and frail. This approach heals much better than a full length or ministernotomy, cutting through the breast bone
Here are the questions to ask when searching for the right treatment and surgeon:
Am I a candidate for minimally invasive aortic valve surgery? And if not, why not?
Do you perform this type of surgery?
How many of these operations have you performed and with what outcomes?
What type of valve or repair do you suggest and why?
Could I talk to any of your previous minimally invasive valve surgery patients? An experienced minimally invasive heart surgeon would have no difficulty finding patients willing to share their experience with you
If you are not satisfied by the answers, call a reputable minimally invasive heart center that will be glad to connect you to an expert heart surgeon and will supply any required information.