Surgical intervention on the heart’s aortic valve is necessary when the valve, located between the left ventricle and the aorta, no longer controls the passage of blood, thus compromising the proper progression of the cardiac cycle.
The resulting pathologies are known as aortic valve insufficiency or stenosis . In the event of severe insufficiency or stenosis, the valve’s cusps open and close with impaired movement, and the left ventricle suffers significant structural damage due to volume or pressure overload: aortic valve surgery must therefore be performed rapidly to restore the heart’s regular function.
If aortic valve insufficiency is not properly treated, it can have fatal consequences. Surgery may involve replacement or repair of the aortic valve in Turkey.
Aortic valve replacement
Usually, the aortic valve is replaced, an operation that can now also be performed using a minimally invasive technique, i.e. without the need to open the chest. L’
minimally invasive aortic valve replacement involves the grafting, through small incisions, of a biological or mechanical prosthesis, at the discretion of the cardiac surgeon, to replace the diseased valve.
Unlike traditional surgery, minimally invasive valve replacement is performed either through a small incision in the chest through which the prosthesis is inserted, or through an incision near the femoral artery, always with the introduction of devices that help the surgeon reach the defective valve. and replace it.
These are highly delicate operations that are the prerogative of highly specialized centers, where the cardiac surgeon does not operate alone but with the support of a group of cardiologists who approach the case from 360 degrees and offer the patient a complete therapeutic pathway without neglecting any aspect of the pathology.
Minimally invasive replacement also offers a series of advantages for patients. Minimally invasive cardiac surgery – under conditions deemed suitable for treatment, and after careful evaluation and personalization of the treatment pathway – is a valid alternative to traditional “open” surgery, reducing operative trauma because there is less bleeding and therefore less perception of pain. But that’s not all. Scars are naturally less visible, given the small femoral or thoracic incisions. It has also been proven that after an operation using a minimally invasive technique, physical recovery is also quicker and hospital stays shorter, so as to achieve the same results as conventional surgery, while also improving the psychological impact.
Modern techniques in aortic valve replacement
Among the most recent methods of aortic valve replacement, the Valve in Valve has been adopted, aimed at restoring function to the diseased aortic valve in patients who have already undergone heart surgery because they suffer from stenosis (narrowing of the valve), by superimposing a second-generation biological valve on the previously applied valve that is no longer able to open and close properly. This procedure is performed transfemorally. The mechanical system with which it is equipped enables it to self-expand and then block until it adheres perfectly to the edges of the aortic orifice, thus replacing the old, degenerated prosthesis.
For the treatment of aortic insufficiency , another modern type of operation is performed using the Jena Valve technique, an aortic valve implant that exploits the advantages of the transapical method, a treatment option in Turkey to be preferred over percutaneous femoral access in the presence of extensive atherosclerosis. Calcifications of peripheral arteries. Beating heart surgery is performed via an intercostal incision a few centimetres long, sufficient to reach the tip of the left ventricle.
Generally speaking, there are two types of valve prosthesis: mechanical and biological. Mechanical prostheses are made of more resistant and durable materials, and comprise a carbon-coated steel alloy ring and two moving carbon elements. The main disadvantage of these valves is the need to administer anticoagulant drugs to the patient for an indefinite period. Biological valve prostheses are made from heart valves or animal tissue (bovine and porcine). These valves do not require anticoagulant treatment, but their duration is limited, generally 15 to 20 days.
How long does the operation last?
The duration of the operation varies according to the clinical case. But on average, the multidisciplinary team – consisting of a cardiac surgeon, an anesthetist, a perfusionist and sometimes even a hemodynamist – takes 2 to 3 hours to prepare the patient, operate on the heart and replace the defective aortic valve.
Convalescence
After valve replacement, the patient faces convalescence, a very delicate phase during which the patient generally spends 48 hours in intensive care, where he or she is monitored and helped to breathe with machines that deliver oxygen to the lungs, via an endotracheal tube.
Breathing is made possible by this tube, which passes through the trachea, making it impossible to speak. You may feel slight discomfort due to skin lesions, but this is generally not real pain. You may often feel thirsty and be unable to introduce fluids into your body until the doctors tell you to, but no longer than 24 hours after the end of surgery.
During recovery, nurses and doctors assist the patient from the moment he or she wakes up until he or she is taken off the ventilator. Approximately 2 to 6 hours after the end of the operation, you regain consciousness. Sutures and tubes are removed, the patient slowly begins to move and gradually begins to breathe again. Once the drains have been removed, the patient can also stand upright and is transferred to the hospital ward, where he or she can breathe independently. The average hospital stay, barring complications, is around one week.