Our Summary

This study looked at the results of a type of heart surgery, specifically aortic root replacement with valve-sparing reimplantation of bicuspid aortic valves (BAV), compared to tricuspid aortic valves (TAV). The aortic valve is part of the heart that helps control the flow of blood. Some people have two parts, or “cusps,” to their aortic valve (BAV), while others have three (TAV).

From 2002 to 2017, researchers followed 92 adults who had surgery with BAV reimplantation and 515 with TAV reimplantation at the Cleveland Clinic. They took into account 28 different factors before the surgery and then compared the results afterwards.

Their findings show that both types of surgery can be performed safely and have good outcomes in the medium term. However, the BAV group did have some higher measures such as higher pressure gradients (how much the blood pressure changes), less reverse remodeling of the left ventricle (less reduction in the size of the heart’s main pumping chamber), and more need for more aortic valve surgeries.

So, while both surgery types are generally safe and effective, the BAV group does have some potential issues that doctors and patients should keep an eye on over the long term.

FAQs

  1. What is the difference between bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV)?
  2. What were the main findings of the study comparing BAV and TAV surgeries performed at the Cleveland Clinic between 2002 and 2017?
  3. Are there any potential issues or risks associated with BAV reimplantation as compared to TAV reimplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about aortic valve replacement is to closely monitor their blood pressure, heart size, and follow-up appointments to ensure the best long-term outcomes. It’s important to stay proactive in managing any potential complications that may arise after surgery. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can also help support overall heart health and recovery.

Suitable For

Patients who are typically recommended for aortic valve replacement include those with severe aortic stenosis (narrowing of the aortic valve), aortic regurgitation (leaking of the aortic valve), or aortic aneurysm (weakening and enlargement of the aorta). These conditions can lead to symptoms such as chest pain, shortness of breath, fatigue, and heart palpitations, as well as an increased risk of complications such as heart failure, stroke, and sudden cardiac death.

In the study mentioned above, patients with bicuspid aortic valves (BAV) were specifically compared to those with tricuspid aortic valves (TAV) in terms of outcomes following aortic root replacement surgery. BAV is a congenital heart condition where the aortic valve has two cusps instead of three, and it is associated with a higher risk of aortic valve complications over time.

Ultimately, the decision to undergo aortic valve replacement surgery is based on a thorough evaluation by a multidisciplinary team of cardiologists, cardiac surgeons, and other healthcare providers. Factors such as the severity of the valve condition, the presence of symptoms, the patient’s overall health and medical history, and the potential risks and benefits of surgery are all taken into consideration when determining the most appropriate treatment plan for each individual patient.

Timeline

  • Before the surgery: The patient experiences symptoms of aortic valve disease, such as chest pain, shortness of breath, fatigue, and fainting spells. They undergo diagnostic tests such as echocardiograms, CT scans, and angiograms to confirm the diagnosis and determine the severity of the disease.

  • Day of surgery: The patient is admitted to the hospital and undergoes preoperative preparations, such as fasting and anesthesia administration. The surgery itself typically lasts several hours, during which the damaged aortic valve is replaced with a mechanical or biological valve.

  • Postoperative recovery: The patient is closely monitored in the intensive care unit (ICU) for the first 24-48 hours after surgery. They may require mechanical ventilation, medication to control pain and prevent infection, and physical therapy to prevent blood clots and improve lung function.

  • Hospital stay: The patient remains in the hospital for 5-7 days on average, during which time they are gradually weaned off of mechanical support and monitored for any signs of complications, such as bleeding, infection, or arrhythmias.

  • Follow-up care: The patient is discharged from the hospital with instructions for medications, diet, and activity restrictions. They are scheduled for regular follow-up appointments with their cardiologist to monitor their progress and adjust their treatment plan as needed.

Overall, aortic valve replacement surgery is a major procedure that requires careful planning, skilled execution, and attentive postoperative care to ensure the best possible outcome for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about aortic valve replacement include:

  1. What type of aortic valve replacement surgery do you recommend for me - bicuspid aortic valve (BAV) reimplantation or tricuspid aortic valve (TAV) reimplantation?
  2. What are the potential risks and benefits associated with each type of surgery?
  3. How long is the recovery process for each type of surgery, and what can I expect during the recovery period?
  4. What follow-up care will be needed after the surgery, and how often will I need to see a doctor for check-ups?
  5. Are there any lifestyle changes or medications that I will need to take after the surgery?
  6. What signs or symptoms should I watch for that may indicate a complication or need for further treatment?
  7. How long can I expect the replacement valve to last, and are there any limitations or restrictions on my activities after the surgery?
  8. Are there any alternative treatment options to consider for my condition?
  9. Can you provide me with more information on the long-term outcomes and potential complications associated with aortic valve replacement, specifically for BAV reimplantation versus TAV reimplantation?
  10. Are there any specific factors about my individual health or condition that may impact the success of the surgery or my long-term prognosis?

Reference

Authors: Mokashi SA, Rosinski BF, Desai MY, Griffin BP, Hammer DF, Kalahasti V, Johnston DR, Rajeswaran J, Roselli EE, Blackstone EH, Svensson LG. Journal: J Thorac Cardiovasc Surg. 2022 Jan;163(1):51-63.e5. doi: 10.1016/j.jtcvs.2020.02.147. Epub 2020 May 11. PMID: 32684389