33400 Valvuloplasty, aortic valve; open, with cardiopulmonary bypass

Name of the Procedure:

Valvuloplasty, aortic valve; open, with cardiopulmonary bypass
Common names: Open aortic valvuloplasty, Surgical valvuloplasty, Aortic valve repair

Summary

Open aortic valvuloplasty is a surgical procedure designed to repair a malfunctioning aortic valve. It involves opening the chest and using a heart-lung machine (cardiopulmonary bypass) to allow surgeons to repair the valve, improving its function and blood flow through the heart.

Purpose

This procedure addresses problems with the aortic valve, such as aortic stenosis (narrowing of the valve) or aortic regurgitation (leaking of the valve). The goals are to improve heart function, reduce symptoms like chest pain and shortness of breath, and enhance overall quality of life.

Indications

• Severe aortic stenosis causing symptoms or affecting heart function
• Aortic regurgitation leading to heart failure symptoms
• Congenital valve abnormalities
• Failure of non-surgical treatments or less invasive procedures

Preparation

• Fasting for 8-12 hours before surgery
• Adjustments to medications, especially blood thinners
• Comprehensive diagnostic tests, including echocardiogram, chest X-ray, and blood tests
• Preoperative assessments, including anesthesiology evaluation

Procedure Description

1. General anesthesia is administered.
2. An incision is made in the chest (sternotomy) to access the heart.
3. Cardiopulmonary bypass is established using a heart-lung machine.
4. The heart is temporarily stopped, and the aortic valve is exposed.
5. The malfunctioning valve is repaired using surgical techniques tailored to the specific problem.
6. The heart is restarted, and the chest incision is closed with sutures or staples.
7. Cardiopulmonary bypass is discontinued, and the patient is stabilized.

Duration

Typically lasts 3 to 5 hours.

Setting

Performed in a hospital operating room.

Personnel

• Cardiothoracic surgeons
• Anesthesiologists
• Perfusionists (manage the heart-lung machine)
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common: Bleeding, infection, irregular heart rhythms, reactions to anesthesia
• Rare: Stroke, heart attack, kidney failure, valve dysfunction, need for reoperation

Benefits

• Improved valve function and blood flow
• Relief from symptoms like chest pain and shortness of breath
• Enhanced quality of life and potential longevity
• Benefits usually realized within days to weeks post-surgery

Recovery

• Initial hospital stay of 5 to 7 days, including ICU monitoring
• Pain management with medications
• Gradual increase in activity levels
• Full recovery typically takes 6 to 12 weeks
• Follow-up appointments for evaluation and cardiac rehabilitation

Alternatives

• Medication management for symptom control
• Balloon valvuloplasty (less invasive, often temporary solution)
• Transcatheter aortic valve replacement (TAVR, less invasive but not suitable for all patients)
• Pros and cons depend on patient's condition, age, and overall health

Patient Experience

• During: Under general anesthesia, no awareness or pain
• After: Pain and discomfort managed with medication, immediate need for ICU care
• Experiences vary, but most patients report gradual improvement in symptoms and overall well-being

Pain management is a key focus, and patients report being well-supported during recovery.