Aortic insufficiency surgery overview

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 * Associate Editor-In-Chief:Mohammed A. Sbeih, M.D.[mailto:msbeih@perfuse.org]

Related Key Words and Synonyms: Aortic valve replacement.

Overview
Aortic valve replacement is indicated in patients with severe aortic insufficiency who are either symptomatic or those who have a left ventricular end-diastolic diameter >55 mm or 25 mm/m2 or an left ventricular ejection fraction <55%.

The majority of patients with severe aortic regurgitation requiring surgery undergo aortic valve replacement instead of aortic valve repair which is sometimes preformed at highly specialized surgical centers which have appropriate technical expertise and experience in selecting potential patients.

Advanatges of A Mechanical Valve
Mechanical valves are made of man-made (synthetic) materials, such as a metal like titanium. Mechanical heart valves do not fail often. They last from 12 to 20 years. However, blood clots develop on them. If a blood clot forms, the patient may have a stroke. Anticoagulation with warfarin will be required which can be associated with bleeding.

Advantages of A Bioprosthetic Valve
Bioprosthetic valves are made of human or animal tissue.Biological valves do not require anticoagulation, but they tend to fail over time. Patients with a biological valve may need to have the valve replaced in 10 to 15 years.

Selecting A Mechanical Verssus a Bioprosthetic Valve
The 2006 American College of Cardiology/American Heart Association (ACC/AHA) recommendations for the choice of aortic valve :


 * If the patient is under 65 years of age and does not have a contraindication to anticoagulation then a mechanical valve is preferred.
 * If the patient is ≥65 years of age and does not have risk factors for thromboembolism, then a bioprosthetic valve is reasonable
 * If the patient already has a mechanical valve in the mitral or tricuspid position and already requires anticoagulation, then a mechical valve is preferred
 * If the patient has active prosthetic valve endocarditis, then the valve should be replaced
 * If the patient has contraindications to anticoagulation therapy regardless his or her age, then a bioprosthetic valve is indicated

Operative Mortality
The risk of death or serious complications from isolated aortic valve replacement is typically between 1-3%, depending on the health and age of the patient, as well as the skill of the surgeon and the health care institute. The patient's past history of heart surgery affects the mortality rate as well.