Surgical options for Aortic Valve Replacement (AVR)
Posted Apr 02 2014 12:51pm
Consultant Cardiologist, Mr Mike Mullen and Cardiac Surgeon, Mr John Yap explain the latest treatment options for replacing a damaged heart valveA structure that allows fluid to flow in one direction only, preventing backflow.. This is an important combination of heart specialists, because it helps to provide the broad view from the patient perspective and not just the approach adopted by a particular type of specialist.
During the course of our lives, our hearts will beat 2000 Million times. That is alot of beats for delicate structures and so it is perhaps not surprising that they do sometimes get worn out or damaged.Valve tissueA group of cells with a similar structure and a specialised function. can either become too narrow 'stenosed', or bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. leaks around them and this is called 'regurgitation' or 'incompetence'.
To begin with the pathology can be dealt with quite well, but symptoms then develop including:
Breathlessness on walking
Aortic stenosisNarrowing of a tubular structure or valve. is diagnosed by the presence of a heart murmurA sound produced by the turbulent blood flow within the heart or arteries, heard with a stethoscope., which can be heard by a doctor using a stethoscope. The murmur is caused by turbulent blood not being competently passed through the valve. The diagnosisThe process of determining which condition a patient may have. can be confirmed by heart ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. or echocardiogramAn ultrasound examination of the heart as it is pumping. Also known as an 'echo'..
Aortic stenosis cannot be treated by medicines. The traditional treatment is by open heart surgery to remove the narrowed valve and replace it. The authors explain the pros and cons with this approach. However, new minimally invasive methods now include Trans Catheter Valve Implantation or TAVI, and Balloon Aortic Valvuplasty (BAV). In addition there are a selection of different types of articial and biological valves.
When deciding on the most appropriate option it is important for the patient to be included in the multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. team decision process.
The authors conclude by saying, "Aortic stenosis is the most common form of valvular heart disease and if untreated is often fatal. Timely intervention to replace the valve can both improve symptoms and increase lifespan and therefore, in general, should not be delayed once symptoms develop. There are many treatment options for patients including open heart surgery and transcatheter aortic valve implantation (TAVI). A multidisciplinary heart team is essential to consider the most appropriate treatment for each patient."