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Aortic Valve Replacement

Why doesn't my heart valve work properly?

Heart Interior From The Illustrated Field Guide to Congenital Heart Disease and Repair - Second Edition courtesy of Scientific Software Solutions Inc.

The valves in your heart may be damaged due to infection, rheumatic heart disease or birth (congenital) defects. The affected valve leaflets (cusps) may grow thick and brittle from scar tissue or calcium deposits, or they may become thin and weak resulting in an inefficient valve.

There are several terms referring to valve disease.

  • Stenosis - the opening of the valve becomes smaller, thus allowing less blood to flow through.
  • Regurgitation/Insufficiency (leaky valve) - the valve does not close properly and allows blood to flow backward as well as forward in the heart.

How will I feel?

Due to the damaged valve, your heart must work harder to pump blood throughout the body.  You may tire easily and feel short of breath with less activity or exercise.  You may experience an irregular heartbeat due to over-stretching of the heart muscle as in mitral stenosis, or dizziness and near fainting due to decreased blood flow to the brain as in aortic stenosis.

How will my valve be fixed?

Surgical Replacement

Depending on the extent of your valve disease, you may need to have the valve repaired or replaced.  To repair the valve, your surgeon may perform a commissurotomy or implant a valve ring.  A commissurotomy is performed for a tight valve (stenosis).  The valve leaflets are cut to loosen the valve slightly, allowing blood to pass easily.  Another type of valve repair is a valve ring annuloplasty, which is sewn in place when the valve is leaking (regurgitant or insufficient).  The valve leaflets are tucked in place with the ring.

Often the valve cannot be repaired and the surgeon must replace the damaged valve with a tissue (bioprosthetic) or mechanical valve.  Tissue valve are valves from animals (e.g., cow, pig).  They generally do not require long-term anticoagulation and are not as durable as mechanical valves.  Mechanical valves are made from materials such as plastic or metal.  They require long-term anticoagulation and are considered extremely durable, lasting longer than tissue valves.

Your surgeon will discuss the need for repair or replacement of the valve with you prior to surgery as well as the type of valve (tissue or mechanical) should replacement be necessary. 

Annuloplasty Ring

Annuloplasty Ring

Tissue Valve

Tissue Valve

Mechanical Valve

Mechanical Valve

Transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement is an alternative option for patients who may be at high risk or extreme risk for open heart surgery. This is a much less invasive procedure than open heart-valve surgery.
In this procedure, the damaged heart valve would be replaced using a heart valve made of natural tissue obtained from the heart of a pig. An incision would be made and the new valve is delivered via catheter, thereby avoiding open heart valve surgery. Special imaging equipment is used to guide position and placement of the new valve. The catheterization procedure typically takes one to three hours, and patients are up and walking within 24-48 hours after the procedure. The typical hospital stay is three to five days.

There are two active clinical trials for the TAVR procedure. Find out more about the Pivotal Trial for High Risk Patients and the Continued Access Protocol for Extreme Risk Patients.

Click here to watch a Q&A video from cardiac surgeon John Conte and cardiologist Jon Resar about the eligibility, risks, recovery and benefits of the TAVR procedure.

Johns Hopkins Hospital is also performing TAVR in selected patients with the Edwards Sapien aortic valve. This transcatheter delivered valve is is FDA-approved for patients who are not candidates for conventional open heart surgery.

 

Transcatheter Aortic Valve Replacement (TAVR) | Q&A

Professor of Surgery John Conte and Associate Professor of Medicine Jon Resar discuss the Transcatheter Aortic Valve Replacement (TAVR) procedure -- one of the treatment options for aortic stenosis. They also share insights on eligibility, risks, recovery and benefits of TAVR.

 

Valve Replacement Surgery: What else should I know?

Prevention of Valve Infection

To prevent an infection (endocarditis) from occurring around the new heart valve or ring, you should receive antibiotics before having any procedures that could permit bacteria to enter your body.  Among these procedures are:

  • All dental procedures (cleaning, filling, removing teeth, root canals, gum or ulcer treatment). You may use dental floss, In fact, we encourage you to reduce tartar with any approved method.
  • Surgical procedures such as colonoscopy, cystoscopy, or other surgical procedures.

Discuss with your dentist or doctor whether the dosage of Coumain (warfarin) needs to be decreased or stopped before any of the above procedures.

Signs and Symptoms of Common Infections

Notify your family doctor if you have any of the following signs or symptoms of an infection:

  • Respiratory:  Fever higher than 101oF, or coughing up white, yellow or green tinged mucus.
  • Urinary:  Fever higher than 101oF, or burning, frequency, urgency or difficulty to urinate.
  • Blood:   Any fever that last longer than two days and is accompanied by chills, weakness, general feeling of ill health.


Identification

You will receive a valve identification card from the valve manufacturer that contains information about the type and size of your heart valve.  Carry this with you at all times.  Remember, you must tell any doctor or dentist caring for you about your valve and the need for antibiotics.

Valve Clicking

A mechanical heart valve (such as a St. Jude or Carbomedics) may produce a clicking sound as it closes.  Some patients are more aware of this sound than others.  It can be louder with activity or more noticeable when you are resting.  As you adjust to the sound, it will become less distracting.

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