Aortic Valve Disease

The aortic valve is a one-way valve between the main pumping chamber of the heart, the left ventricle, and a large arterial trunk, the aorta, which carries blood to the rest of your body. This valve can malfunction in two ways: (1) aortic stenosis, which represents significant narrowing of the valve opening, usually due to stiffening and calcification of the valve leaflets and (2) aortic regurgitation, whereby the valve allows significant amounts of blood to leak backwards down into the heart.

In aortic stenosis, the heart must work harder to pump blood past the narrowed valve and throughout the body. The principal symptoms associated with aortic stenosis include shortness of breath (dyspnea), chest tightness (angina), and fainting episodes (syncope). Left untreated for many months to years, severe aortic stenosis can lead to irreversible changes in your heart muscle that can lead to heart failure. With aortic regurgitation, much of the blood that is pumped forward across the valve leaks back into the left ventricle, causing it to dilate over time. As with aortic stenosis, untreated aortic regurgitation often manifests as shortness of breath and can lead to heart failure.

At Yale Cardiac Surgery, we understand that the thought of undergoing aortic valve surgery can be overwhelming. Our surgeons will review your surgical plan with you in detail so that you know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their minimally invasive surgical techniques and high level of skill in aortic valve repair and replacement.

Treatment

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Severe aortic valve disease is generally treated with aortic valve replacement surgery in which the native, diseased valve is replaced with an artificial valve.

There are two major classes of artificial valves: biologic valves made out of animal or human tissue and mechanical valves made out of fabric and metal. Mechanical valves are extremely durable, but generally require that you take a blood thinner called Coumadin for the rest of your life. Biologic valves do not require Coumadin, but they are less durable, generally lasting between 10 and 15 years; worn out valves often require another operation to replace them.

Frequently Asked Questions

The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. When it is damaged or functioning poorly, the surrounding tissue must be repaired, or the valve itself must be replaced surgically. 

Aortic valve replacements require the use of cardiopulmonary bypass, otherwise known as “the heart-lung machine.” This machine permits the surgeon to safely open the aorta and access the valve. In most cases, the heart is also stopped for about an hour. 

The operation involves opening of the aorta and removal of the diseased aortic valve leaflets. After the physician measures the valve ring and determines the correct size of the replacement, the valve is lowered into place, the aorta is closed, and the heart is restarted.

The entire operation takes about two or three hours to complete.
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There are two major types of aortic valve prostheses – mechanical and tissue. 

Mechanical replacement valves have lifelong durability, however a blood thinning drug must be taken for the rest of the patient’s life to prevent blood clots from forming on the hinges of the valve. Besides being somewhat of a nuisance, taking blood thinners also create a small risk of bleeding complications. 

Tissue or “bioprosthetic” valves are made of cow or pig tissue. Because they are made of natural materials, there isn’t a need to take blood thinners. However they are less durable, lasting about 10-15 years. 

Your doctor will help you make a decision on which kind of aortic valve replacement to pick based on your age, occupation, lifestyle, medical history, and preference.
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