33411 Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus

Name of the Procedure:

Replacement, Aortic Valve; with Aortic Annulus Enlargement, Noncoronary Sinus
Common Name(s): Aortic Valve Replacement with Annuloplasty, Aortic Valve and Annular Enlargement

Summary:

This procedure involves the replacement of a damaged or diseased aortic valve with a new valve. Additionally, it includes the enlargement of the aortic annulus (the ring-like structure that connects the valve to the heart) at the noncoronary sinus to ensure the new valve fits properly and functions efficiently.

Purpose:

This procedure addresses severe aortic valve stenosis (narrowing) or regurgitation (leakage). The goals are to restore normal blood flow from the heart, alleviate symptoms such as chest pain and shortness of breath, and prevent complications like heart failure.

Indications:

• Severe aortic stenosis or regurgitation
• Symptoms like breathlessness, angina, and fainting spells
• Unsuccessful or unsuitable results from less invasive methods like balloon valvuloplasty
• Suitable candidates include patients with adequate overall health to undergo major surgery

Preparation:

• Fasting for 6-8 hours prior to surgery
• Adjustments in medications as directed by the healthcare team
• Preoperative evaluations like echocardiograms, chest X-rays, and blood tests
• Discontinuing blood thinners to reduce bleeding risk

Procedure Description:

1. Anesthesia: General anesthesia to ensure the patient is unconscious and pain-free.
2. Incision: A median sternotomy (a vertical incision along the sternum) is performed to access the heart.
3. Cardiopulmonary Bypass: Connecting the patient to a heart-lung machine to take over blood circulation and oxygenation.
4. Valve Removal: The damaged aortic valve is carefully excised.
5. Annulus Enlargement: The aortic annulus is enlarged using a special patch at the noncoronary sinus to accommodate a larger valve.
6. Valve Replacement: The new aortic valve is sutured into place.
7. Closure: The heart is restarted, and the incision is closed in layers.

Equipment Used: Scalpel, heart-lung machine, surgical retractor, sutures, and prosthetic valve.

Duration:

Typically, the procedure lasts between 4-6 hours.

Setting:

This surgery is performed in a hospital, specifically in a specialized cardiac surgery operating room.

Personnel:

• Lead Surgeon: Cardiothoracic surgeon
• Assisting Surgeon: Assistant surgeon or resident
• Anesthesiologist: Manages anesthesia and patient’s vital functions
• Surgical Nurses: Assist with instruments and patient care
• Perfusionist: Manages the heart-lung machine

Risks and Complications:

• Bleeding
• Infection
• Blood clots leading to stroke or heart attack
• Valve malfunction or leakage
• Arrhythmias
• Rarely, death

Benefits:

• Relief from symptoms such as shortness of breath and chest pain
• Improved quality of life and physical activity capacity
• Prevention of heart failure and other complications
• Benefits are usually realized within a few weeks to months post-surgery

Recovery:

• Initial recovery in the ICU for close monitoring
• Hospital stay ranges from 5-10 days
• Instructions include wound care, medication management, and dietary restrictions
• Gradual return to normal activities over 6-8 weeks
• Follow-up appointments for monitoring heart function and valve performance

Alternatives:

• Medication management for symptom control (limited effectiveness for severe conditions)
• Transcatheter Aortic Valve Replacement (TAVR) for patients at high surgical risk
• Pros of alternatives include less invasiveness; cons include possibly less durable results compared to surgical valve replacement

Patient Experience:

• During Procedure: The patient will be under general anesthesia and will not feel anything.
• After Procedure: Expect soreness and discomfort at the incision site, manageable with pain medications.
• Hospital Recovery: Includes monitoring, gradual resumption of mobility, and pain management strategies.
• Home Recovery: Gradual increase in activity, avoiding heavy lifting, and adhering to follow-up plans.