Aortic valve replacement or aortic valve replacement is an open heart surgery procedure performed to treat patients with aortic valve disorders. This procedure aims to replace a malfunctioning or damaged aortic valve. valve adamaged orta is replaced with valve aorta artificial, of synthetic materials or tissues body animal.
The aorta is the largest artery that is directly connected to the heart, and is responsible for transporting oxygen-rich blood from the heart to the rest of the 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 the heart has. Aortic valve that does not function 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
An aortic valve replacement procedure is performed under the following conditions:
- Aortic valve regurgitation, This is a condition in which the aortic valve of the heart cannot close tightly. This condition causes some of the blood supply already in the aorta to return to the left ventricle (ventricle). Symptoms of aortic valve regurgitation 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 blocked, so that blood accumulates not only in the left ventricle, but also in the part of the heart that drains blood to the left ventricle, namely the atrium. Symptoms of aortic valve stenosis include fainting, chest pain (angina) ), shortness of breath, palpitations, and tired quickly 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 aortic valve disease. The condition of the aortic valve can get worse if not treated immediately. The worst result is heart failure.
There is no cure for aortic valve disease. Therefore, the aortic valve replacement procedure is the main action to overcome it.
Aortic Valve Replacement Warning
Patients with aortic valve disease who also have kidney and lung disease should exercise caution before undergoing aortic valve replacement surgery.
Preparation for Aortic Valve Replacement
Talk to your doctor about the procedure you will undergo, the risks, or complications that may occur. Before surgery, the doctor will perform a physical examination, medical history, especially whether you have allergies to anesthetics (anesthesia), and perform blood tests, electrocardiography (ECG), echocardiography, and X-ray examinations.
Tell your doctor about any medications you are taking. The doctor will assess whether or not to stop the drug. Patients need to fast from eating and drinking since the night before surgery, and not smoking before the surgical procedure.
Aortic Valve Replacement Procedure
Valve replacement surgery takes several hours depending on the patient's condition. The doctor will start the procedure by giving you an anesthetic. Anesthesia will make the patient unconscious and do not feel pain during the operation.
After giving the anesthetic, the cardiac surgeon will make a long incision about 25 cm in the middle of the breastbone, or can also make a small incision as an access to open the heart area. A tube or catheter will be connected between the heart, the large underlying vessels, and the machine that replaces the work of the heart. During surgery, the heart will be made to stop beating.
After that, the doctor will give drugs that can stop the work of the heart. This condition allows doctors to perform surgery on the heart.
The doctor will remove the damaged aorta when the valve opens. The old aortic valve is replaced by a new aortic valve by means of suturing using fine threads. The valves used can be:
- Artificial mechanical valve.
- Valves made of animal tissue (bioprosthesis), such as cows or pigs, or tissue taken from the human heart (homograft).
About 80 percent of patients have an aortic valve bioprosthesis. This network is believed to be more secure and durable up to 15-20 years.
After the stitches, the heart's function will be restored to normal with the help of an electric shock device. Tool bypass The heart is then removed. Next, the sternum will be reattached with wires. The surgical wound on the chest will be closed with a number of stitches.
The valve replacement method can also be performed without an incision. This procedure is called a transcatheter aortic valve replacement.transcatheter aortic valve replacement/TAVR) or also called 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. A tube is threaded through a vein to the aortic valve. After that, a new aortic valve was placed.
The doctor will perform the TAVR procedure if the patient:
- Have a moderate to high risk of complications after surgery.
- Ever replaced the aortic valve with biologic tissue.
After Aortic Valve Replacement
Valve replacement patients will wake up a few hours after surgery. When you wake up for the first time, the patient 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 you painkillers when the anesthetic wears off. The airway connection remains in place until the patient can breathe normally.
Then, the patient was transferred to the intensive care unit (intensive care unit/ICU). Other actions that can be taken in the ICU include:
- Insertion of a pacemaker to control heart rate.
- Drainage of fluid in the chest to remove the buildup of fluid and blood in the chest cavity.
- Use of a urinary catheter.
- Attachment of cables 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 family or close relatives to drive you home. You still need their help when doing activities at home. Consult a doctor about the actions that should not be done after undergoing an aortic valve replacement procedure.
Complications of Aortic Valve Replacement
Poor health conditions and elderly people are at risk for complications after undergoing aortic valve replacement surgery. These complications include:
- Infections in the surgical wound, bladder, lung or heart valves, and antibiotics can be given to reduce the risk of infection.
- Excessive bleeding.
- Heart rate disturbances or arrhythmias.
- Transient ischemic attack (TIA)This is a temporary blockage of the blood supply to the brain.
- Death.