33410 Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve

Name of the Procedure:

Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve
Common Name(s): Aortic valve replacement (AVR), Open-heart aortic valve replacement

Summary

An open aortic valve replacement involves surgically opening the chest and using a heart-lung machine (cardiopulmonary bypass) to replace a damaged aortic valve with a stentless tissue valve. This procedure restores proper blood flow out of the heart and into the aorta, improving overall heart function.

Purpose

This procedure is performed to:

• Correct aortic valve stenosis (narrowing of the valve)
• Address aortic valve regurgitation (leakage of the valve) The goal is to relieve symptoms such as chest pain, shortness of breath, and prevent heart failure, thereby improving quality of life and longevity.

Indications

• Severe aortic valve stenosis or regurgitation
• Symptoms such as shortness of breath, chest pain, fainting
• Echocardiogram showing impaired valve function
• Ineffectiveness of less invasive treatments like medications

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or stopping certain medications, as advised by the healthcare provider
• Blood tests, chest X-ray, electrocardiogram (EKG), and echocardiogram to evaluate heart function and ensure readiness for surgery

Procedure Description

1. The patient is put under general anesthesia.
2. A median sternotomy is performed to open the chest.
3. The patient is connected to a heart-lung machine (cardiopulmonary bypass) to maintain circulation and oxygenation.
4. The damaged aortic valve is removed.
5. A stentless tissue valve is carefully stitched into place.
6. The heart is then taken off the bypass machine, and normal circulation is restored.
7. The chest is closed with sutures or staples.

Duration

The procedure typically takes about 4 to 6 hours.

Setting

This surgery is performed in a hospital operating room equipped with heart surgery capabilities.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)
• Surgical assistants

Risks and Complications

• Common: Infection, bleeding, irregular heartbeats, and blood clots
• Rare: Stroke, heart attack, valve malfunction, reactions to anesthesia
• Complications are managed with appropriate medical interventions, including medications and additional procedures.

Benefits

• Improved heart function and blood flow
• Relief from symptoms associated with aortic valve disease
• Enhanced quality of life and increased survival rates Benefits are typically noticed within weeks of recovery.

Recovery

• Initial hospital stay of about 5 to 10 days
• Pain management with medications
• Gradual increase in activity level guided by healthcare provider
• Follow-up appointments to monitor heart function
• Full recovery may take a few months, with restrictions on heavy lifting and strenuous activities during this period

Alternatives

• Transcatheter Aortic Valve Replacement (TAVR): Less invasive, suitable for high-risk patients
• Medications: Manage symptoms but do not replace the valve
• Balloon Valvuloplasty: Temporarily relieves symptoms in certain cases Each alternative has its pros and cons, with TAVR being less invasive but not suitable for all valve conditions.

Patient Experience

• During the procedure: The patient is under full anesthesia and will feel no pain.
• After the procedure: Pain at the incision site managed with medications, discomfort from the chest tubes, and limited mobility initially.
• Gradual progression to normal activities with support from healthcare team.

Pain management and adequate support are provided to ensure patient comfort throughout the recovery process.