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Aortic valve replacement is typically an open-heart surgery. But a minimally invasive method—using surgery or a catheter procedure—may be an option for some people.
In conventional open-heart surgery, the surgeon makes an incision in the chest and then spreads the ribs to expose the
heart. This type of incision is called a sternotomy.
In minimally invasive heart surgery, the surgeon makes a smaller incision in the chest. The
aortic valve is located near the front of the chest. So surgeons have discovered
that aortic valve replacement can be done successfully through this
Surgeons may do this minimally invasive surgery in different
ways. These variations include different ways to:
Despite these variations, in all other ways the technique for
replacing the aortic valve is the same in minimally invasive surgery as in
conventional valve surgery.
Less invasive surgery may have benefits over conventional valve
replacement surgery. These benefits can include:
Transcatheter aortic valve replacement is a new way to replace an aortic valve. It is done to treat aortic valve stenosis. It does not require open-heart surgery. It uses a thin, flexible tube called a catheter. The catheter is inserted through a small incision into a blood vessel, typically in the groin. The catheter is moved through blood vessels and into the heart. A specially designed artificial valve fits inside the catheter and is moved inside of the damaged aortic valve. The artificial valve expands and works as the aortic valve.
This procedure is available in a small number of hospitals. It is not right for everyone. It might be done for a person who cannot have surgery or for a person who has a high risk of serious problems from surgery. For example, it might be an option if you are not healthy enough for an open-heart surgery.
Although this procedure is minimally invasive, it has serious risks including stroke, heart muscle damage, heart block, kidney problems, and death. The long-term results of this procedure are not known yet.
Whether one of these methods is right for you depends on a lot of things including your health and your personal feelings.
You will likely talk with your doctor about the potential benefits
and risks for you. Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and talk about it with your doctor.
Other Works Consulted
Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
Holmes DR Jr, et al. (2012). 2012 ACCF/AATS/SCAI/STS Expert consensus document on transcatheter aortic valve replacement. Journal of the American College of Cardiology, 59(13): 1200–1254.
Rosengart TK, et al. (2008). Percutaneous and minimally invasive valve procedures. A scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation, 117(13): 1750–1767.
November 11, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& David C. Stuesse, MD - Cardiac and Thoracic Surgery
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