Diagnosing aortic valve repair
Our team determines enlargement or dilatation of the aortic root before surgery by using several imaging techniques including computed tomography (CT) scan, cardiac magnetic resonance imaging (Cardiac MRI) and echocardiography. Valve abnormalities can be better determined with transesophageal echocardiography (TEE).
This ultrasound technique is performed in all patients who undergo aortic valve surgery in our institution. After the repair is performed and while still on the operating table, all patients have their valve inspected using TEE to determine the adequacy of the repair.
A successful outcome is indicated by the absence of aortic valve regurgitation or presence of very minimal regurgitation. Any question regarding the results prompts further corrections to achieve a perfect outcome. This approach requires a team of physicians who have expertise in assessing aortic valve disorders and its repair.
Aortic valve repair is a new surgical approach
Repair of the aortic valve is a relatively new surgical approach to the treatment of aortic valves that have developed aortic regurgitation.
- During aortic valve repair, the native aortic valve is preserved, and the aortic cusps are reconstructed to allow for a normal flow of blood from the heart to the aorta, without returning.
- In contrast to the valve replacement, aortic valve repair does NOT require the use of blood thinners. Treatment with blood thinners requires a careful diet and frequent check-ups to avoid problems with excessive blood thinning or clotting, both of which can lead to serious complications. Avoiding blood thinners with procedures like aortic valve repair can simplify and improve quality of life considerably in the long run.
- The long-term valve durability with an aortic valve after a repair is excellent and similar to the mechanical valves. In contrast, an aortic valve replaced by a tissue valve (cow, pig, and more recently, horse) have limited durability, and historically, many patients needed a repeat replacement at 10-15 years.
Candidates for aortic valve repair are patients with aortic regurgitation or insufficiency. Aortic valve disease is frequently associated with enlargement (aneurysm) of the ascending aorta, which is the initial portion of the aorta. If the enlargement of the aorta is substantial (usually above 4.5 or 5 cm in diameter), this part of the aorta may need to be replaced at the same time that the aortic valve is repaired or replaced.
Aortic valve cusp prolapse repair
Aortic annulus dilation
Aortic valve cusp fenstration
A technique that allows cardiovascular surgeons to repair the aortic valve and replace the enlarged ascending aorta from the sinotubular junction to the arch is called the David procedure and is routinely performed at Lankenau Heart Institute.