Name of the Procedure:

Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex

• Common Name: Complex Aortic Valve Repair
• Technical Terms: Complex Aortic Valve Valvuloplasty, Open Surgical Aortic Valve Reconstruction

Summary

Valvuloplasty for the aortic valve is an open-heart surgery involving the repair of the aortic valve via complex techniques and necessitates the use of a cardiopulmonary bypass machine. Techniques include leaflet extension, resection, reconstruction, or annuloplasty.

Purpose

This procedure is intended to correct aortic valve deformities that obstruct blood flow or cause leakage. The goal is to restore normal valve function, thereby improving heart efficiency and relieving symptoms such as shortness of breath, chest pain, and fatigue.

Indications

• Severe aortic valve stenosis or regurgitation
• Symptoms including breathlessness, angina, or syncope
• Heart failure signs due to aortic valve dysfunction
• Patients not suitable for valve replacement due to specific criteria like age or co-morbid conditions

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments to medications as per doctor’s instructions
• Pre-operative tests like echocardiogram, ECG, blood tests, and possibly cardiac catheterization

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A median sternotomy (incision in the middle of the chest) is made.
3. Cardiopulmonary Bypass: The heart-lung machine is connected to take over the heart’s function during surgery.
4. Valve Repair: The surgeon performs necessary repairs:
   • Leaflet extension using pericardial or synthetic patches
   • Leaflet resection or reconstruction to reshape or remove damaged portions
   • Annuloplasty to tighten or reinforce the valve ring
5. Completion: The heart is restarted, and the incision is closed.

Duration

The procedure typically takes 4-6 hours.

Setting

The surgery is performed in a hospital operating room, specifically in a cardiac surgery suite.

Personnel

• Cardiothoracic Surgeon
• Surgical Nurses
• Anesthesiologist
• Cardiovascular Perfusionist
• Surgical Assistants

Risks and Complications

• Common: Bleeding, infection, reaction to anesthesia, arrhythmias
• Rare: Stroke, heart attack, valve dysfunction recurrence, need for repeat surgery
• Management: Intensive care monitoring, medications, potential reoperation

Benefits

• Improved quality of life with reduced symptoms
• Enhanced heart function and circulation
• Potentially prolonged life expectancy
• Results can be seen in a few weeks to months post-surgery

Recovery

• Hospital stay of about 5-10 days, including ICU
• Activity restrictions for 4-6 weeks
• Follow-up appointments and possible cardiac rehabilitation
• Pain management with prescribed medications and instructions for wound care

Alternatives

• Medications: For symptom management but not a cure
• Aortic valve replacement: Surgical or transcatheter approach; pros and cons depending on patient’s condition
• Balloon valvuloplasty: Less invasive but generally temporary solution for certain patients

Patient Experience

During the procedure:

• The patient is under general anesthesia and will not feel pain. After the procedure:
• Pain at the incision site managed with medications
• Feeling of fatigue and weakness during initial recovery
• Discomfort from chest tubes if used, which are removed during the hospital stay
• Gradual resumption of activities as per doctor’s guidance, with close monitoring for complications or recurrent symptoms

Pain management includes medications, proper wound care, and gradual increase in physical activities to promote healing and recovery.