Surgical valve replacement by open heart surgery
For the open-heart aortic valve replacement procedure, the heart is stopped and the patient is connected to a ventilator and a heart-lung machine. An 18 cm incision is made on the midline of the sternum and then it is pulled apart with the help of open heart surgical instrument set. The thorax is then opened with special separators which update the lungs and the pericardium (hard tissue envelope) which is between the lungs and which protects the heart.
Patients considered to be at high risk for aortic valve replacement with open heart surgery are those for whom doctors believe the surgery can lead to life-threatening complications.
Implantation of a percutaneous aortic valve
When a percutaneous aortic valve is implanted, a small incision is made in the femoral artery (in the crease of the groin) and a new aortic valve is implanted through a catheter. Given the non-invasive nature of the procedure, implantation of a percutaneous aortic valve may present less risk of complications, reduce the length of recovery and improve living conditions.
Implantation of a percutaneous aortic valve
The percutaneous aortic valve implantation procedure is different from conventional open-heart aortic valve replacement procedures.
The next paragraph describes the operating mode of the implantation procedure. This is a general presentation. Your situation may be different. You should approach your doctor to discuss the specific details of the procedure.
During the intervention
Similar to other well-known cardiac procedures, such as angioplasty and stent implantation, percutaneous aortic valve implantation involves the insertion of a catheter through an artery in the groin using special imaging equipment to guide the positioning and placement of the percutaneous aortic valve. Patients receive light sedation during the procedure, which lasts about 1 to 2 hours, and they feel no pain. Since every patient is different, it is your doctor who will decide whether or not you should be totally asleep during the procedure.
- The interventional cardiologist or cardiac surgeon makes a small incision in the groin, then inserts an introducer (a hollow, long tube) into the femoral artery and then assembles a guide through the heart.
- Thanks to special imaging equipment to visualize your arteries, a catheter with a balloon at its end is inserted into the introducer into the heart. You may feel palpitations in the chest. This is due to the abnormal heartbeat that occurs after the catheter is inside the heart.
- When the end of the balloon is in the aortic valve, the balloon is inflated to force the constricted aortic valve to open to prepare it for percutaneous aortic valve implantation.
- The percutaneous aortic valve is delivered through the introducer into the heart.
- Using the special imaging equipment again, the doctor will position the percutaneous aortic valve where the diseased aortic valve is located.
- The new implanted heart valve turns on immediately. The doctor performs a test to verify that the valve is working properly.
- The catheter is removed, the small incision in the groin is closed and the procedure is completed.
After the intervention
After implantation of the percutaneous aortic valve, the patient is admitted to the intensive care or cardiology department. In general, patients are able to get up and walk within 24-48 hours of the procedure.
The doctor will determine the appropriate time for transfer to a normal room. Hospitalization time after percutaneous aortic valve implantation is usually 3 to 5 days. In addition, you should report any pain you feel or any other symptoms that may be related to the new heart valve to your doctor.
The doctor will give you specific instructions for medical follow-up and any restrictions. You will need to continue to take your prescribed medications and have the valve and heart checked regularly. Check with your doctor or medical staff about appointments for medical follow-up as well as any questions relating to your condition as a carrier of a new heart valve.
Tell your dentist that you have a tissue valve. During dental procedures, bacteria can be released into the bloodstream and cause infection of a tissue valve. This means that you should be given antibiotic treatment before any dental work, even simple scaling.
As a precaution, you should tell other doctors that you have a heart valve before any medical intervention. It is important to attend the cardiologist’s appointments and follow their daily care instructions for the best possible results.
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