If you suffer from common heart conditions like aortic stenosis or mitral regurgitation, heart valve surgery can repair damaged valves or replace them to restore normal heart function. Our cardiovascular surgeons in Nashville specialize in complex valve procedures and will discuss the best option based on your unique condition.
Types of Heart Valve Surgery
We use the latest techniques for the following procedures:
- Aortic valve repair/replacement
- Aortic homograft, stentless aortic valve replacement
- Standard (sutured) aortic valve replacement
- Transcatheter aortic valve replacement (TAVR)
- Aortic root enlargement
- Sutureless aortic valve replacement
- Transcatheter aortic valve replacement
- Mitral valve repair (Classical Carpentier + Contemporary neochordal reconstructive techniques)
- Mitral valve replacement
- Tricuspid valve repair
- Tricuspid valve replacement, including Extracellular matrix (ECM)-based valve replacement
Aortic valve surgery performed to replace an aortic valve that is not working properly due to narrowing (stenosis) or leakage (regurgitation). The aortic valve is located between the pumping chamber (ventricle) on the left side of the heart, and the aorta (a major artery). The aorta carries oxygen-rich blood from the heart to the rest of the body. The valve should be closed tightly while the heart is filling with blood. When the heart chamber squeezes to push blood into the aorta, the valve should open fully to allow blood flow.
During this procedure, your cardiovascular surgeon will make an incision in the aorta to remove the damaged valve, sew a new valve into place, and stitch the aorta back together.
Sometimes, the aortic valve is misshaped due to a birth defect. Other times, it works well for years before becoming too stiff or too floppy to open and close fully. This is called aortic valve disease. As you age, calcium builds up on the valve making it more difficult to function properly. Other conditions that cause valve problems include:
- Rheumatic valve disease
- Aortic aneurysms
- Aortic dissection
- Aortic valve stenosis
- Aortic valve regurgitation
Healthy heart valves permit one-way flow of blood. Diseased valves leak, causing backflow, or narrow, restricting blood flow. In either case, the condition can be life-threatening. Sometimes the valve can be repaired, but more often it requires a replacement heart valve.
If your mitral valves are too narrow (stenotic) from birth or because of damage to the valve, a valvulopasty can be used to repair the valve. Using a catheter, a tiny balloon can be expanded inside the valve to stretch it open. Floppy mitral valves also require repair to correct leaking or mitral regurgitation (MR). Mitral valve disease can also be caused by elongation or rupture of the chordal apparatus, the “heart strings” that support the valve. Your heart surgeon will work to correct these structures and improve valve function.
When the mitral valves are too damaged, you will need a heart valve replacement. During this open-heart surgery, your surgeon will sew the new heart valve into place. When this is complete, you will be taken off the heart-lung machine and you heart will be restarted and the incision will be closed.
There are two types of replacement prosthetic (artificial) valves– biological valves or mechanical valves.
- Biological (tissue) valves are taken from a pig (porcine), cow (bovine), or human donors. Xneograft valves are made from animal tissue. Biological valves don’t last as long as mechanical valves, but you usually don’t need anticoagulation therapy.
- Mechanical valves are created from man-made materials like metal or plastic and are very durable. However, patients with these mechanical valves must take anticoagulants for the rest of their lives. This medication will prevent blood clots from forming on or around the valve.
Homograft Valve Replacement
A homograft (also called allograft) is an aortic or pulmonic valve that has been removed from a donated human heart, persevered, antibiotic treated, and frozen under sterile conditions. Homografts may be used to replace a diseased aortic valve or to replace a pulmonic valve during the Ross procedure.
The Ross procedure is usually performed on patients younger than 40-60 years old who want to avoid taking long-term anticoagulation medications after surgery. During this procedure, the patient’s own pulmonary valve is removed and used to replace the diseased aortic valve. The pulmonary valve is then replaced with a pulmonary homograft. The Ross operation is not for everyone. Your cardiovascular surgeon will talk with you about all of your options for your unique condition.