33405 Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve

Name of the Procedure:

Replacement, Aortic Valve, Open, with Cardiopulmonary Bypass; with Prosthetic Valve Other Than Homograft or Stentless Valve

Summary

This procedure involves replacing a damaged aortic valve with a prosthetic valve using open-heart surgery. Cardiopulmonary bypass (a heart-lung machine) is used to circulate blood and oxygen through your body during the surgery.

Purpose

The procedure addresses aortic valve diseases, such as aortic stenosis or aortic regurgitation, where the valve either doesn't open fully or leaks, respectively. The goal is to restore normal blood flow out of the heart, improve symptoms, and extend the patient's life expectancy.

Indications

Common symptoms warranting this procedure include severe chest pain (angina), breathlessness, fainting spells (syncope), and heart failure symptoms. It is appropriate for patients whose condition has progressed despite medication, those with severe valve dysfunction, and those who are good candidates for open-heart surgery.

Preparation

Patients are typically instructed to fast for 8-12 hours before surgery. Pre-procedure preparations include blood tests, an electrocardiogram (ECG), chest X-rays, and an echocardiogram. Medications may need to be adjusted, and certain medications like blood thinners may be paused.

Procedure Description

1. The patient receives general anesthesia.
2. An incision is made along the breastbone to access the heart.
3. The patient is connected to a cardiopulmonary bypass machine.
4. The heart is temporarily stopped, and the aortic valve is exposed.
5. The damaged valve is removed and replaced with a prosthetic valve.
6. The new valve is checked for proper function before weaning off the bypass machine.
7. The heart and circulation are restored, and the chest is closed.

Special tools include surgical instruments for opening the chest, the cardiopulmonary bypass machine, and the prosthetic valve.

Duration

The surgery typically lasts about 4-6 hours.

Setting

This procedure is performed in a hospital operating room with an intensive care unit (ICU) for post-operative care.

Personnel

Involved healthcare professionals include cardiothoracic surgeons, anesthesiologists, surgical nurses, and perfusionists.

Risks and Complications

Common risks include bleeding, infection, and blood clots. Rare but severe complications can include stroke, heart attack, or even death. Long-term risks include prosthetic valve dysfunction that may require further interventions.

Benefits

Successful valve replacement can significantly relieve symptoms, improve heart function, and enhance quality of life. Many patients experience noticeable improvement within weeks, though long-term benefits are typically seen in the coming months.

Recovery

Initial recovery involves a hospital stay of approximately 5-7 days, including ICU monitoring for the first 1-2 days. Full recovery can take several weeks to months. Patients will need to avoid heavy lifting and strenuous activities, follow a cardiac rehabilitation program, and attend regular follow-up appointments.

Alternatives

Other options include transcatheter aortic valve replacement (TAVR), balloon valvuloplasty, or simply managing the condition with medications. Each has its pros and cons related to the patient's overall health, the severity of valve disease, and potential for long-term benefit.

Patient Experience

During surgery, patients are under general anesthesia and will not feel pain. Post-operatively, they may experience discomfort or pain at the incision site, managed with pain medications. Patients usually feel tired and weak initially but gradually regain strength through rehabilitation. Pain and discomfort are managed carefully to ensure patient comfort.