Aortic valve replacement

From WikiMD free medical encyclopedia
Jump to: navigation, search
Wellness.png

WikiMD is a free medical encyclopedia moderated by medical professionals and is a reliable source of information on a wide range of health, weight loss and wellness related topics. Who wants to trust their health with amateurs?

Let Food Be Medicine, Medicine Be Food - Hippocrates

Template:Interventions infobox

File:Diagram of the human heart (cropped).svg
Diagram of the opened heart, viewed from the front. The aortic valve separates the left ventricle from the aorta.
File:Gray495.png
Heart viewed from above, with atria removed to expose the valves.

Aortic valve replacement is a procedure in which a patient's failing aortic valve is replaced with an artificial heart valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency / regurgitation) or partially blocked (aortic stenosis). Current aortic valve replacement approaches include open heart surgery, minimally invasive cardiac surgery (MICS) and minimally invasive, catheter-based (percutaneous) aortic valve replacement.

A catheter-based approach (percutaneous aortic valve replacement or PAVR) may eliminate the need for open heart surgery in select groups of patients. As of October 2012, in the USA there is an FDA-approved percutaneously implantable aortic valve system for high surgical risk and inoperable patients with symptomatic aortic stenosis with other catheter-based devices on trial use.

Types of heart valves

There are two basic types of artificial heart valve: mechanical valves and tissue valves.

Tissue valves

Tissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.

There are alternatives to animal tissue valves. In some cases a homograft - a human aortic valve—can be implanted. Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves. Another procedure for aortic valve replacement is the Ross procedure (or pulmonary autograft). In a Ross procedure, the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.

Mechanical valves

Mechanical valves are designed to outlast the patient, and have typically been stress-tested to last several hundred years. Although mechanical valves are long-lasting and generally present a one-surgery solution, there is an increased risk of blood clots forming with mechanical valves. As a result, mechanical valve recipients must take anticoagulant (blood thinning) drugs such as warfarin for the rest of their lives, making the patient more prone to bleeding. The sound of mechanical valves may be heard and decrease the quality of life.[1]

Valve selection

Tissue valves tend to wear out faster with increased flow demands - such as with a more active (typically younger) person. Tissue valves typically last 10–15 years in less active (typically elderly) patients, but wear out faster in younger patients. When a tissue valve wears out and needs replacement, the person must undergo another valve replacement surgery. For this reason, younger patients are often recommended mechanical valves to prevent the increased risk (and inconvenience) of another valve replacement.

Surgical procedure

Aortic valve replacement is most frequently done through a median sternotomy, meaning the incision is made by cutting through the sternum. Once the pericardium has been opened, the patient is put on a cardiopulmonary bypass machine, also known as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.

Once the patient is on bypass, a cut is made in the aorta and a crossclamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. Transesophageal echocardiogram (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.

Hospital stay and recovery time

After aortic valve replacement, the patient will frequently stay in an intensive care unit for 12–36 hours. The patient is often able to go home after this, in about four days, unless complications arise. Common complications include heart block, which typically requires the permanent insertion of a cardiac pacemaker.

Recovery from aortic valve replacement will take about three months, if the patient is in good health. Patients are advised not to do any heavy lifting for 4–6 months after surgery, to avoid damage to the sternum (the breast bone).

Surgical outcome and risk of procedure

The risk of death or serious complications from aortic valve replacement is typically quoted as being between 1-3%, depending on the health and age of the patient, as well as the skill of the surgeon. Older patients, as well as those who are frail and/or have multiple comorbidities (i.e. other health problems), may face significantly higher surgical risk.

Minimally invasive cardiac surgery

More recently, some cardiac surgeons have been performing aortic valve replacement procedures using an approach referred to as minimally invasive cardiac surgery (MICS), in which the surgeon replaces the valve through small incisions between two to four inches in length using specialized surgical instruments rather than by cutting a six to ten-inch incision down the center of the sternum. MICS typically involves shorter recovery time and more attractive cosmetic results.[2]

Percutaneous aortic valve replacement

Percutaneous aortic valve replacement implants the valve using a catheter, without open heart surgery. It is used in more than 50 countries in patients who are at extreme or high risk to undergo open heart surgery. The SAPIEN valve is made by Edwards Lifesciences. The Medtronic CoreValve system is another device used for this procedure, undergoing clinical trials in the United States.

In high-risk patients with severe aortic stenosis, transcatheter and surgical procedures for aortic-valve replacement had similar rates of survival at 1 year, although there were important differences in risks associated with the procedure.[3] In the PARTNER trial, there was an early increased hazard of stroke in the first 30 days associated with TAVR (4.6% with TAVR vs. 2.4% with surgical replacement, P=0.12), but more strokes occurred in the surgical group during the followup period.[4] Hemodynamic valve improvement, quality of life outcomes and the composite outcome of death from any cause or stroke did not differ significantly between the two treatment groups. Patients treated with the percutaneous procedure enjoyed a shorter recovery time with faster improvements in quality of life measures, although the two groups were equal in quality of life outcomes by 1 year.[4]

See also

References

Also see the following articles on Aortic valve replacement

Metabolic.jpg

Featured disease

Metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high triglycerides, low HDL cholesterol and high blood pressure.

Affects one in three adults

Affecting about 35 percent of all adults in the United States according to the CDC, metabolic syndrome contributes to weight gain, by causing a state of internal starvation called metabolic starvation. This in turn leads to increases hunger, sugar cravings and increased portions leading to overeating and weight gain.

Cause and effect misunderstood

Since we traditionally thought that the portion control (which in turn was attributed wrongly to poor will power)is the cause of weight gain, rather than the effect of this metabolic starvation, all our traditional ideas about cause and effect of obesity were not only wrong but lead to the “blame the victim” attitude when it comes to obesity.

Secret of weight gain revealed

Secret of weight gain, and metabolic syndrome revealed - it has been recently proven that metabolic syndrome, and the weight gain itself are caused by a process called insulin resistance. Check your metabolic syndrome risk using the free Metabolic syndrome meter. Watch this amazing Ted Med video that reveals the secret of weight loss - Stop blaming the victim for obesity


Template:Cardiac surgery

External links



WikiMD Resources for Aortic valve replacement

Articles on Aortic valve replacement

Govt. policies / Guidelines
  1. UpToDate on Aortic valve replacement
  2. Most recent articles on Aortic valve replacement
  3. Most cited articles on Aortic valve replacement
  4. Review articles on Aortic valve replacement
  5. Articles on Aortic valve replacement in N Eng J Med, Lancet, BMJ
  1. US National Guidelines Clearinghouse on Aortic valve replacement
  2. NICE Guidance on Aortic valve replacement
  3. NHS PRODIGY Guidance
  4. FDA on Aortic valve replacement
  5. CDC on Aortic valve replacement

Media articles Aortic valve replacement

Patient Resources / Community
  1. slides on Aortic valve replacement
  2. Images of Aortic valve replacement
  3. Photos of Aortic valve replacement
  4. Podcasts & MP3s on Aortic valve replacement
  5. Videos on Aortic valve replacement
  1. Patient resources on Aortic valve replacement
  2. Discussion groups on Aortic valve replacement
  3. Patient Handouts on Aortic valve replacement
  4. Directions to Hospitals Treating Aortic valve replacement
  5. Risk calculators and risk factors for Aortic valve replacement

Evidence Based Medicine

Healthcare Provider Resources
  1. Cochrane Collaboration on Aortic valve replacement
  2. Bandolier on Aortic valve replacement
  3. TRIP on Aortic valve replacement
  1. Symptoms of Aortic valve replacement
  2. Causes & Risk Factors for Aortic valve replacement
  3. Diagnostic studies for Aortic valve replacement
  4. Treatment of Aortic valve replacement

Clinical Trials

News on Aortic valve replacement
  1. Ongoing Trials on Aortic valve replacement at Clinical Trials.gov
  2. Trial results on Aortic valve replacement
  3. Clinical Trials on Aortic valve replacement at Google
  1. Aortic valve replacement in the news
  2. Be alerted to news on Aortic valve replacement
  3. News trends on Aortic valve replacement

Definition of Aortic valve replacement

Flickr on Aortic valve replacement
  1. Definitions of Aortic valve replacement
  1. Flickr on Aortic valve replacement

Books on the topic

Facebook posts Aortic valve replacement
  1. Books on Aortic valve replacement
  1. Facebook posts related to Aortic valve replacement

Continuing medical education (CME)

Tweets about Aortic valve replacement
  1. CME Programs on Aortic valve replacement
  1. Twitter tweets related to Aortic valve replacement
Pintest on Aortic valve replacement Commentary & #Aortic valve replacement
  1. Pintest on Aortic valve replacement
  1. Blogs on Aortic valve replacement
  2. #Aortic valve replacement



W8md2.jpg

World's largest food, health, weight loss, wellnesspedia and encyclopedia

If you are a medical professional or an expert in any field of medicine, please join us in building the world's largest weight loss and wellness encyclopedia created by experts in the field, not by the crowd. WikiMD is sponsored by W8MD weight loss, sleep and medical aesthetic centers


W8MD Weight Loss, Sleep & Medical Aesthetic Centers

Since its inception in 2011, W8MD’s insurance physician weight loss program has successfully helped thousands of patients succeed in not only losing weight but also keep it off with an ongoing maintenance plan.

FANTASTIC PROGRAM. TRULY A LIFE CHANGER. D.M. LOST 100 LBS^^

weight loss success stories

^^Individual results may vary.

Weight-loss.jpg

W8MD weight loss, sleep and medical spa blogs


Support our sponsors

W8MD weight loss, sleep and medspa centers sponsors WikiMD.

W8MD's Locations for losing weight, sleeping better and looking your best

Philadelphia

weight loss Philadelphia | Sleep center Philadelphia

King of Prussia

Lose weight King of Prussia | sleep doctor King of Prussia

New York

Weight loss NYC | Fast weight loss NYC | Lose weight NYC | Sleep apnea NYC

New Jersey

New Jersey Weight Loss, Sleep and Medical Spa Cherry Hill NJ

Other W8MD blogs

Lorcaserin weight loss | Qsymia weight loss | Phentermine weight loss | Weight loss blog | Free weight loss | Saxenda weight loss | Contrave weight loss


Cite error: <ref> tags exist, but no <references/> tag was found

WikiMD Sponsors - W8MD Weight Loss, Sleep and MedSpa Centers

Pronounced weightMD, our state of the art W8MD weight loss, sleep, holistic IV nutrition and aesthetic medicine programs can help you not only to lose weight, and sleep better but also look your best! Since its inception in 2011, W8MD’s insurance physician weight loss program has successfully helped thousands of patients.

W8MD Weight Loss

W8MD’s Physician weight loss is unique in many ways with a comprehensive multidisciplinary approach to weight loss. Weight Loss Success Stories....

W8MD Sleep Services

Sleep medicine program uses state of the art technology to diagnose and treat over 80 different sleep disorders. W8MD Sleep Services…

W8MD Medical Aesthetic Services

Medical aesthetic program offers a wide variety of advanced laser skin treatments including oxygen super facials, photofacials and Affordable Botox. W8MD Aesthetic Services…

IM and IV nutrition therapy includes booster shots for B12, vitamin B complex, Vitamin C, Detox treatments and IV nutrition therapy. W8MD IV Nutrition…

W8MD weight loss | Philadelphia medical weight loss | NYC medical weight loss | NJ medical weight loss

W8MD Weight Loss, Sleep & Medical Aesthetics

Intro to W8MD Weight Loss, Sleep & Medical Aesthetics


Disclaimer: The entire contents of WIKIMD.ORG are for informational purposes only and do not render medical advice or professional services. If you have a medical emergency, you should CALL 911 immediately! Given the nature of the wiki, the information provided may not be accurate and or incorrect. Use the information on this wiki at your own risk! See full Disclaimers.WikiMD is supported by W8MD Weight loss, Poly-Tech Sleep & Medical Aesthetic Centers of America.