Name of the Procedure:

Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)

Summary

This procedure replaces a diseased or malfunctioning aortic valve with a donor (allograft) valve. The surgery is performed through an open-chest approach, involving the use of cardiopulmonary bypass to maintain circulation and oxygenation during the procedure.

Purpose

The procedure addresses severe aortic valve diseases such as aortic stenosis or aortic regurgitation. The goal is to restore normal valve function, improve blood flow from the heart, reduce symptoms, and prevent heart failure.

Indications

• Severe aortic stenosis (narrowing of the aortic valve)
• Aortic regurgitation (leakage of the aortic valve)
• Congenital valve defects that impair function
• Symptoms like chest pain, shortness of breath, or syncope (fainting)
• Evidence of heart damage due to valve disease

Preparation

• Patients may need to fast for at least 8 hours before surgery.
• Certain medications, particularly blood thinners, may need to be adjusted.
• Preoperative evaluations include blood tests, chest X-rays, electrocardiograms (ECG), and echocardiograms.
• Detailed discussions regarding the procedure, risks, and recovery plan.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A midline sternotomy (incision through the breastbone) is performed to access the heart.
3. Cardiopulmonary Bypass: The heart is connected to a heart-lung machine to take over the functions of the heart and lungs.
4. Valve Removal: The diseased aortic valve is carefully excised.
5. Allograft Valve Placement: The donor valve is meticulously sutured into position.
6. Restoring Circulation: The heart is taken off cardiopulmonary bypass and normal heart function resumes.
7. Closure: The sternum is wired shut and the incision is closed with sutures or staples.

Duration

The procedure typically takes 3 to 5 hours.

Setting

The procedure is performed in a hospital operating room equipped with advanced surgical and monitoring equipment.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the heart-lung machine)
• Surgical Technicians

Risks and Complications

• Infection at the incision site
• Bleeding or blood clots
• Stroke or heart attack
• Valve malfunction or failure
• Reaction to anesthesia
• Prolonged recovery or need for repeat surgery

Benefits

• Relief from symptoms such as shortness of breath, chest pain, and fatigue.
• Improved heart function and quality of life.
• Reduced risk of heart-related complications, including heart failure.

Recovery

• Hospital stay of about 5 to 7 days, including intensive care immediately after surgery.
• Pain management with medications.
• Gradual return to activities over 6 to 8 weeks.
• Follow-up appointments to monitor recovery and valve function.
• Cardiac rehabilitation programs may be recommended.

Alternatives

• Medical management with medications (less effective for severe cases)
• Transcatheter aortic valve replacement (TAVR) for patients who are high-risk surgical candidates
• Mechanical or bioprosthetic valve replacements
  • Pros: Potentially longer-lasting results with mechanical valves.
  • Cons: Continuous blood-thinning medication required for mechanical valves; bioprosthetic valves may not last as long as allograft valves.

Patient Experience

• During the procedure, the patient will be under general anesthesia and feel no pain.
• Postoperatively, there may be discomfort or pain at the incision site, managed with pain relief medications.
• Feelings of fatigue and weakness are common initially, gradually improving with recovery.
• Emotional support and reassurance are beneficial during the recovery phase.

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