Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)
CPT4 code
Name of the Procedure:
Valvuloplasty, Aortic Valve, Open, with Cardiopulmonary Bypass; Simple (i.e., Valvotomy, Debridement, Debulking, and/or Simple Commissural Resuspension)
Summary
An open valvuloplasty for the aortic valve is a surgical procedure to repair a damaged aortic valve in the heart. It involves making an incision in the chest, using a heart-lung machine to maintain blood circulation, and repairing the valve to improve its function.
Purpose
This procedure addresses issues with the aortic valve that impede proper blood flow from the heart to the rest of the body. The goals are to restore normal valve function, relieve symptoms, and prevent further cardiac complications.
Indications
- Severe aortic stenosis (narrowing of the valve)
- Aortic valve regurgitation (leaky valve)
- Congenital aortic valve defects
- Symptoms such as chest pain, shortness of breath, fainting, or heart failure
- Ineffectiveness of medication or less invasive treatments
Preparation
- Fasting for a specific period before surgery
- Adjustment of certain medications
- Comprehensive preoperative assessments, including blood tests, echocardiogram, ECG, and imaging studies
- Consultation with anesthesia and surgical teams
Procedure Description
- Patient is placed under general anesthesia.
- Surgeon makes an incision in the chest to access the heart.
- The patient is connected to a cardiopulmonary bypass machine (heart-lung machine) to maintain blood flow and oxygenation during the surgery.
- The surgeon opens the aorta to expose the aortic valve.
- Depending on the specific needs, the surgeon performs:
- Valvotomy: Cutting and separating stiffened valve leaflets.
- Debridement: Cleaning and removing calcium deposits.
- Debulking: Reducing excessive valve tissue.
- Simple Commissural Resuspension: Repositioning valve commissures.
- The aorta is then closed, and the heart is allowed to resume its function.
- The chest incision is closed, and the patient is taken off the bypass machine.
Duration
The procedure typically takes 3-4 hours.
Setting
The procedure is performed in a hospital operating room equipped with cardiopulmonary bypass facilities.
Personnel
- Cardiothoracic surgeon
- Surgical nurses
- Anesthesiologist
- Perfusionist (operates the heart-lung machine)
- Cardiovascular surgical assistants
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Stroke
- Heart attack
- Valve dysfunction
- Issues related to anesthesia
- Potential need for further heart surgery
Benefits
- Improved blood flow and heart function
- Relief from symptoms such as chest pain, shortness of breath, and fatigue
- Potentially longer life expectancy and better quality of life
Recovery
- Intensive monitoring immediately post-surgery in the ICU.
- Hospital stay typically lasts 5-7 days.
- Activity restrictions for 4-6 weeks.
- Gradual resumption of normal activities based on doctor’s advice.
- Regular follow-up appointments to monitor heart function and recovery progress.
Alternatives
- Medication management (less effective in severe cases)
- Balloon valvuloplasty (less invasive but may not provide lasting results)
- Transcatheter aortic valve replacement (TAVR) (minimally invasive procedure, suitable for certain patients with higher surgical risks)
Patient Experience
During the procedure: The patient is under general anesthesia and will not feel pain or be aware during the surgery.
After the procedure:
- Pain and discomfort at the incision site, managed with pain medications.
- Drowsiness and mild confusion initially from anesthesia.
- Monitoring for complications in ICU.
- Gradual improvement in symptoms as recovery progresses.
- Discharge instructions, including wound care, activity restrictions, and follow-up care.
Pain management and support from the medical team are provided to ensure comfort and proper healing.