Our Summary

This research paper looks at how a complex heart surgery called aortic valve reimplantation is performed in smaller hospitals and medical centers. This procedure is usually done in larger, specialized hospitals, so the researchers wanted to see if it could be done just as safely and effectively in smaller places.

To do this, they looked back at the medical records of 72 patients who had this surgery in a single smaller hospital between 2011 and 2020. They tracked how these patients did right after surgery and in the years following the procedure.

The results showed that death in the hospital after surgery was very rare (1.4%) and there were no cases of neurological events (problems with the brain and nervous system) during the period right after surgery. In the years following surgery, two more patients died. However, the overall survival rates at 1 and 5 years after surgery were very high (98.5% and 96.3%, respectively).

During follow-up, a small number of patients (6.9%) needed another surgery on the aortic valve. The rate of moderate and severe aortic regurgitation (a condition where the valve doesn’t close properly and blood leaks back into the heart) at 5 years was also low (6.6% and 0.6%, respectively).

Two factors were associated with a higher chance of moderate or severe aortic regurgitation during follow-up: having mild aortic regurgitation when leaving the hospital and having a procedure called cusp plication (a technique used to repair the valve).

In conclusion, the study suggests that aortic valve reimplantation can be done safely and effectively in smaller hospitals. The rates of death, need for another surgery, and moderate or severe aortic regurgitation in the years following surgery were similar to those seen in larger hospitals.

FAQs

  1. What was the mortality rate for patients who underwent root replacement with reimplantation of the aortic valve in a low-volume center?
  2. How many patients required reoperation on the aortic valve during follow-up?
  3. Are the results from aortic valve reimplantation in a low-volume center comparable to those of high-volume centers?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about aortic valve replacement is to closely follow post-operative care instructions, including taking medications as prescribed, attending follow-up appointments, and maintaining a healthy lifestyle to optimize long-term outcomes and reduce the risk of complications. It is also important to report any new or concerning symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended aortic valve replacement include those with severe aortic valve stenosis or regurgitation, symptomatic patients with heart failure or angina, and patients with aortic valve disease who are at high risk for complications from traditional open-heart surgery. These patients may benefit from aortic valve replacement to improve their symptoms, quality of life, and overall prognosis.

Timeline

Before aortic valve replacement:

  • Patient may experience symptoms such as shortness of breath, chest pain, fatigue, and dizziness
  • Patient undergoes diagnostic tests such as echocardiogram, cardiac catheterization, and blood tests to assess the severity of aortic valve disease
  • Patient consults with a cardiac surgeon to discuss treatment options, including aortic valve replacement
  • Patient undergoes preoperative preparation, including medication adjustments and lifestyle modifications

After aortic valve replacement:

  • Patient undergoes the surgical procedure to replace the aortic valve, either with a mechanical or biological valve
  • Patient is monitored in the intensive care unit postoperatively for any complications
  • Patient is discharged from the hospital and begins cardiac rehabilitation to regain strength and mobility
  • Patient undergoes regular follow-up appointments with their healthcare provider to monitor their recovery and the function of the new valve
  • Patient may need to take medication for the rest of their life to prevent blood clots or other complications
  • Patient may need to make lifestyle changes to maintain heart health, such as eating a heart-healthy diet and exercising regularly.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with aortic valve replacement surgery?
  2. What is the expected recovery time after the surgery?
  3. How long will I need to take medication after the surgery?
  4. What lifestyle changes will I need to make after the surgery?
  5. How often will I need follow-up appointments and monitoring after the surgery?
  6. Are there any restrictions on physical activity or diet following the surgery?
  7. What are the signs and symptoms of complications that I should watch out for after the surgery?
  8. How will the surgery affect my overall heart health and function in the long term?
  9. Will I need any additional procedures or treatments in the future related to the aortic valve replacement?
  10. Are there any specific considerations or precautions I should take in relation to other medical conditions I have?

Reference

Authors: Ntinopoulos V, Papadopoulos N, Odavic D, Haeussler A, Loeblein H, Dzemali O. Journal: Thorac Cardiovasc Surg. 2022 Jun;70(4):297-305. doi: 10.1055/s-0041-1723844. Epub 2021 Feb 18. PMID: 33601468