Minimally Invasive Aortic Valve Replacement

Aortic valve conditions

There are two major conditions that can affect the aortic valve: Aortic Valve Stenosis (AS, with stenosis referring to narrowing) and Aortic Insufficiency or Aortic Regurgitation (AR).

Once these conditions become significant and/or symptomatic (causing symptoms), the best treatment is usually aortic valve replacement (AVR). In very specific cases, aortic valvuloplasty (repair) can also be performed. Mini-AVR stands for minimally invasive aortic valve replacement with minimal incision and minimal trauma.

Who is a candidate for Mini-AVR?

Every patient in need of aortic valve replacement is a candidate for this minimally invasive procedure.

Mini-AVR methodology

Traditionally an aortic valve is replaced by means of a median sternotomy: a 25-to-30-cm vertical inline incision along the sternum, after which the sternum itself is opened. Mini-AVR is performed with a median incision of only 4-to-5-cm and the sternum is only partially divided (hemi-sternotomy).

The 4-to-5-cm incision offers access to the aorta.

The artificial valve is sutured in place using the parachute technique.

Results

Compared with patients undergoing aortic valve replacement with a median sternotomy, Mini-AVR offers more than just cosmetic advantages:

  • Patients experience less pain after surgery (stable chest) allowing improved respiratory function in the immediate postoperative period
  • ​Less time on the heart-lung machine
  • Shorter ventilation period
  • Less blood loss and therefore less blood transfusion requirements
  • Shorter stays in the intensive therapy department
  • Shorter hospital stay
  • Faster recovery
  • Faster resumption of normal activity and faster return to work

From March 2013 to March 2015 our department performed 166 Mini AVR procedures. With none of these patients a conversion to a full sternotomy was required. On average, the hospital stay of patients undergoing Mini-AVR was 3.8 days shorter than that of patients undergoing a full sternotomy for aortic valve replacement.

Conclusions

In addition to the cosmetic benefits, there are clearly other essential advantages to the minimally invasive technique described above.
These benefits do not compromise the short and long term survival of the patients compared with the group of patients undergoing aortic valve replacement the conventional way (median sternotomy).

Artificial valves

There are two types of artificial heart valves: mechanical and biological valves.

Clinical studies have shown that mechanical heart valves are no better or worse than biological heart valves. However, there are differences that make mechanical heart valves more suitable for younger patients and biological heart valves more suitable for older people.

  • Mechanical heart valve prostheses are made of durable material: plastic or carbon and metal. This makes them very resistant to wear and tear. In principle they will last a lifetime. The great advantage of these artificial valves is their durability. A disadvantage is that blood tends to clot on foreign material, so patients require lifelong treatment with powerful blood thinners, which involve risks of bleeding and limitations. Another disadvantage is that the valve is audible.

  • Biological heart valve prostheses (tissue heart valves) are made of specially processed animal tissue (pigs or cows) that is usually mounted on a ring of plastic material, or donor valves of humans (referred to as a homograft). These do not present the problem of rejection, as the heart valve consists of dead tissue. The great advantage of these biological heart valves is that they are silent and do not require the patient to use anticoagulants. Their disadvantage is that they are less durable than the mechanical ones: over the years they will harden resulting in leakage or narrowing, so the valve will eventually need to be replaced again.

Before the procedure, your surgeon will consider which type of surgery, repair or replacement (mechanical or biological artificial valve) is most suitable for you. 

The near and distant future of artificial valve replacement

In some cases, we are currently also replacing valves without open heart surgery. This procedure uses the technique of cardiac catheterisation to lead a folded artificial valve through a catheter to the diseased aortic valve. In medical terms, this is a percutaneous valve implantation. This means that an artificial valve is inserted (implanted) through a small hole in the skin (percutaneous). First, the heart valve is pushed away by dilating a balloon, then the folded artificial valve is put in place and expanded. For the time being, this new technique is mainly used on elderly patients, for whom open heart surgery is too invasive or no longer possible. The procedure is called TAVI (Transcatheter Aortic Valve Implantation).

The existing mechanical and biological prosthetic valves all have drawbacks. An artificial valve made from a person’s own cells could be an excellent alternative. Currently a new generation of artificial valves is being developed by ‘tissue engineering’ autologous material (a person’s own cells). This research is still in an experimental stage and the road to its practical application is still long.

Opname bij een hartoperatie

Nu u van uw arts vernomen heeft dat een hartoperatie voor u de beste behandeling is, zullen er bij u ongetwijfeld een aantal vragen de kop op steken. De brochure die we hiervoor voorzien is niet alleen bedoeld als informatiebron voor u, die een behandeling aan het hart moet ondergaan, maar ook voor uw familie.

In deze informatiebrochure proberen we u antwoorden te geven op uw belangrijkste vragen. U kan deze brochure ook gebruiken als leidraad tijdens uw verblijf op de afdelingen intensieve zorgen en de hospitalisatieafdeling.

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Ontslag na een hartoperatie

Ook na je ontslag zit je beslist met allerhande vragen die we beantwoorden in de brochure 'Ontslag na een hartoperatie'. Deze informatiebrochure volgt op de brochure ‘Opname bij een hartingeep’. De eerste brochure ging vooral over pathologie, de preoperatieve voorbereiding, en het verblijf op de intensieve zorgenafdeling,…

Deze brochure richt zich op het verblijf in het ziekenhuis na een hartingreep, de revalidatie en het verder postoperatief verloop na ontslag uit het ziekenhuis. 

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