Our Summary

This research paper discusses a newer, less invasive method of replacing aortic heart valves, which has seen good results in terms of less trauma from surgery, quicker recovery times, better pain management, and higher patient comfort. The researchers used a smaller cut to imitate the traditional procedure. They avoided damaging the right internal thoracic artery, prevented rib fractures, and performed a total central cannulation (a technique to access the blood vessels), which made the procedure less invasive biologically as well. The central cannulation is also crucial in making perfusion (the passage of fluid through the circulatory system) and drainage simpler. They also discussed how streamlining the procedures and using sutureless prosthesis (an artificial body part) when possible can help reduce the time required for clamping and perfusion. After performing over 1000 right anterior thoracotomy (a surgical incision into the chest wall) aortic valve replacements, the researchers have discovered certain techniques to make their method more effective.

FAQs

  1. What are the benefits of minimally invasive aortic valve replacement?
  2. What is the importance of sparing the right internal thoracic artery during this procedure?
  3. How does the use of a sutureless prosthesis contribute to the efficiency of the procedure?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about aortic valve replacement is to follow post-operative care instructions carefully to ensure proper healing and recovery. This may include taking medications as prescribed, attending follow-up appointments, participating in cardiac rehabilitation programs, and making necessary lifestyle changes such as maintaining a healthy diet and regular exercise routine. It is important for patients to communicate any concerns or symptoms with their healthcare provider to ensure the best possible outcome after surgery.

Suitable For

Patients who are typically recommended aortic valve replacement are those with severe aortic valve stenosis or regurgitation, which can lead to symptoms such as chest pain, shortness of breath, fainting, and heart failure. These patients may have failed medical management or may be at high risk for complications if left untreated. Aortic valve replacement is also recommended for patients with aortic valve disease who are symptomatic and have evidence of left ventricular dysfunction. The decision to undergo aortic valve replacement is made by a multidisciplinary team of cardiologists, cardiac surgeons, and other healthcare professionals based on the individual patient’s clinical presentation and risk factors.

Timeline

Before aortic valve replacement:

  • Patient is diagnosed with aortic valve disease through symptoms such as chest pain, shortness of breath, and fatigue, or through diagnostic tests such as echocardiography.
  • Patient undergoes pre-operative evaluations, including imaging tests, blood tests, and consultations with cardiologists and surgeons.
  • Patient receives education on the procedure, risks, and post-operative care.
  • Surgery date is scheduled and patient is instructed on fasting requirements and medication management.

After aortic valve replacement:

  • Patient is taken into the operating room and anesthesia is administered.
  • Surgeon makes a small incision in the chest, spares the right internal thoracic artery, and performs total central cannulation for perfusion and drainage.
  • Aortic valve is replaced with a sutureless prosthesis to reduce cross-clamping and perfusion times.
  • Patient is monitored in the intensive care unit post-operatively for a few days to ensure stable vital signs and recovery.
  • Patient is transferred to a regular hospital room for further monitoring and rehabilitation.
  • Physical therapy and cardiac rehabilitation are initiated to aid in recovery and improve strength and endurance.
  • Patient is discharged from the hospital and instructed on medications, follow-up appointments, and lifestyle changes to promote heart health.
  • Patient undergoes regular follow-up appointments to monitor progress and ensure long-term success of the aortic valve replacement.

What to Ask Your Doctor

  1. What are the risks and benefits of minimally invasive aortic valve replacement compared to traditional open-heart surgery?
  2. How long is the recovery period for minimally invasive aortic valve replacement?
  3. Will I need to take any medication after the surgery, and if so, for how long?
  4. What follow-up care will be needed after the surgery?
  5. Are there any restrictions on physical activity or diet following the surgery?
  6. How long can I expect the replacement valve to last?
  7. What are the potential complications or risks associated with aortic valve replacement surgery?
  8. Are there any alternative treatment options for my condition?
  9. Will I need any additional tests or evaluations before the surgery?
  10. How experienced is the surgical team in performing minimally invasive aortic valve replacement procedures?

Reference

Authors: Tamagnini G, Biondi R, Giglio MD. Journal: Braz J Cardiovasc Surg. 2021 Feb 1;36(1):120-124. doi: 10.21470/1678-9741-2020-0165. PMID: 33594866