Did the doctor tell you that you need heart surgery? It's normal to feel a little scared when he says that. But today, medicine is very advanced. There are some surgeries that try to protect as many parts of your body as possible. Today we are going to talk about one such very special surgery. That is, the heart valve, which is a surgery that protects the valve.
Simply put, what is Valve-Sparing surgery?
Okay, to understand this, let's first learn about a small part of our heart. The main pumping chamber of our heart (the left ventricle) connects to the largest blood vessel in our body, the aorta. We call this connection the `Aortic Root`. It's like the root of a tree. Inside this `Aortic Root` is a very important gate, the `Aortic Valve`.
Every time the heart beats, this `Aortic Valve` opens and pumps blood into the body, and then closes. This closing stops the blood from flowing back into the heart.
Now imagine, in some people, the `Aortic Root`, that is, the part of the gate that looks like the gate, has weakened, swollen, and become large. It's like a balloon being inflated. We call this `Aortic Root Aneurysm`. When this gate gets large, the door in it, that is, the `Aortic Valve`, doesn't close properly. Then the blood starts leaking back into the heart. This is called `Aortic Regurgitation`.
In the traditional surgery (the `Bentall procedure`), surgeons remove both the bulging `Aortic Root` and `Aortic Valve` and implant two new artificial ones.
But in this Valve-Sparing surgery, something very special happens . What is done here is that only the swollen `Aortic Root` is removed, your own healthy `Aortic Valve` is left as is, and it is grafted onto a new `Aortic Root`. Simply put, it is like changing only the door leaf and fixing your own good old door to it.
The biggest advantage of this is that you can keep your own valve, so you don't need to take lifelong anticoagulant medication (like Coumadin) like you would with a mechanical valve.
What conditions does this surgery treat?
This surgery is mainly performed in the following cases:
- Aortic Root Aneurysm: As I mentioned earlier, this is an abnormal bulge in the root of the aorta that connects to the heart. If this gets too big, it can suddenly burst (`Aortic Dissection` or Rupture). It is very dangerous for life.
- Ascending Aortic Aneurysm with Dilated Aortic Sinuses: Cases where the natural small spaces in the `Aortic Root` (`Aortic Sinuses`) become slightly enlarged, with a bulge in the ascending part of the aorta.
People with certain hereditary connective tissue diseases, such as Marfan syndrome, are at higher risk of developing an aortic root aneurysm. Therefore, surgeons carefully evaluate the patient's condition and weigh the benefits and risks of the surgery before deciding whether it is appropriate.
Are you suitable for this surgery?
If your aortic valve has these characteristics, you may be a candidate for this surgery:
- If there is very little or no calcium deposits (calcification) in the valve.
- Unless the valve has been severely damaged.
- If the valve is working well or can be repaired with a minor repair.
How do you prepare before surgery?
Your surgeon will explain everything you need to do before the surgery. It is very important to follow those instructions exactly. Usually, this is what you will need to do.
| The section to be prepared | What to do |
|---|---|
| Medicines | Tell your doctor about the medications you usually take. Do not stop or change any medications without his advice. |
| Food and water | Do not eat or drink anything (even water) after midnight the night before the surgery. |
| Smoking | Smoking and tobacco products should be completely stopped at least one month before surgery. |
| Someone to help | Arrange for someone to accompany you to the hospital and home. |
In addition, the doctor will perform several tests to plan the surgery, such as:
- Echocardiogram (heart scan)
- Blood tests
- `Cardiac and chest EKG gated CT scan`
- Coronary Angiogram
- Genetic blood test if a hereditary disease is suspected
What happens during the surgery?
This surgery usually takes between 4 and 6 hours. When an experienced surgeon performs this surgery, the heart has to be stopped for about an hour. Don't worry, during that time, a machine will do the work of the heart and lungs.
Here's what happens step by step:
1. Anesthesia: First, you will be put completely to sleep. So you won't feel any pain.
2. Opening the chest: The surgeon makes an incision in the middle of the chest (a `median sternotomy`) to reach the heart.
3. Connecting to the Heart-Lung Machine: You will be connected to a `Cardiopulmonary Bypass` machine. This machine will take over the function of your heart and lungs during the surgery. At this time, a medicine called `cardioplegia solution` will be given to temporarily stop your heart.
4. Releasing the Valve: The surgeon will carefully separate your aortic valve from the surrounding tissue.
5. Removal of damaged parts: The swollen `Aortic Root` and other damaged parts are cut out and removed.
6. Graft: An artificial tube (a `graft`) is implanted in place of the removed part. This is made of a special fabric (`polyester`).
7. Valve re-implantation: Your own aortic valve is taken, a new graft is inserted, and sutured in place.
8. Checking the Valve: To make sure everything is OK, a fluid is passed through the `Graft` to check if the valve is working properly, opening and closing.
9. Final step: The coronary arteries of the heart are connected to the new `Graft`. Then you are removed from the `Heart-Lung Machine` and your heart is allowed to work again. Then the chest incision is closed.
Modern surgical techniques (Modified Reimplantation)
Over time, surgeons have added new techniques to make this operation more successful. For example:
- Creating New Aortic Sinuses (`Neosinuses`): Normally, the `Graft` is a straight tube. But the natural `Aortic Root` has small spaces (`sinuses`). In the new method, such spaces are created artificially in the `Graft`. This makes the blood flow more natural, and the damage to the valve is reduced.
- Aortic Annulus Sizing: The size of the ring-like part that the valve rests on (the `aortic annulus`) is adjusted to fit your body size. This reduces the risk of blood leaking from the valve in the future.
What happens after the surgery? And how long does it take to recover?
After the surgery, you will be kept in the intensive care unit (ICU) for a day or two, and then transferred to a regular ward. You can usually go home in 4 to 7 days.
It takes about 6 weeks to fully recover. Don't rush things at this time. You need to be vigilant and get back to normal.
Even if you have a driver's license, don't drive until your doctor gives you permission. You'll need to wait at least 6 weeks before doing anything like lifting weights or going to work.
Participating in a cardiac rehabilitation program (`cardiac rehab`) will help you recover quickly. Also, be sure to go to follow-up appointments with your doctor. They will continue to monitor the condition of your heart.
What are the risks and benefits of this surgery?
Like any major surgery, there are some risks involved. However, when performed by an experienced surgeon in a hospital with good facilities, these risks are minimal .
Main advantages:
- You don't need to take blood-thinning medication for the rest of your life.
- The risk of blood clots, stroke, and valve infection (endocarditis) is reduced.
- The likelihood of having to have surgery to replace the valve again in the future is very low.
Research has shown that the success rate of this surgery is over 99%. Even after 10 years, about 95% of people who have had this surgery will not need another surgery.
| When to call the doctor after surgery | |
|---|---|
| Changes in the cutting path | Redness, pain, swelling, pus or other fluid draining from the incision. |
| Chest pain or difficulty breathing | Sudden chest pain or difficulty breathing. |
| Other body features | Swelling of the legs, extreme fatigue, fainting, fever, blood in the stool. |
| Cough | A cough with yellow or green phlegm or a cough that brings up blood. |
If you have any of these symptoms, call your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.
Take-Home Message
- Valve-Sparing Aortic Root Replacement is an advanced surgery that replaces only the damaged aortic root, preserving your own healthy aortic valve.
- The biggest advantage of this is that you don't have to take blood-thinning medication for the rest of your life and the risk of having to undergo another surgery in the future is reduced.
- This surgery is not suitable for everyone. Your surgeon will determine if it is appropriate for your situation.
- It takes about 6 weeks to fully recover from surgery. During this time, follow the doctor's instructions exactly.
- If you have any questions, don't be afraid to ask your doctor. The support of your family is also very valuable at this time.
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