UWMTAP

Aortic Valve Preservation

Aortic valve preservation surgery describes a group of procedures that aim to reconstruct a patients’ own valvular tissue to restore function, rather than simply perform a valve replacement. This includes a variety of procedures including aortic valve repair, valve sparing root replacement (VSRR), and the Ross procedure. These interventions aim to restore the “living valve aortic complex”, which we believe offers many advantages to patients. By avoiding aortic valve replacement (with either a biologic or mechanical valve), patients avoid the need for long-term anticoagulation, decrease the risk of prosthetic valve degeneration, and avoid potential prosthetic valve infection (endocarditis). There is also suggestion that patients live longer after valve sparing procedures than with valve replacement, which is especially pronounced in younger patients. In fact, studies have shown that nearly 1 in 5 patients younger than age 65 either are deceased or require reoperation on the aortic valve within 10 years following mechanical aortic valve replacement1. At the University of Washington, we offer solutions to restore the living valve complex for both aortic regurgitation and aortic stenosis.

Aortic Valve Preservation Presentation

Aortic Valve Repair

Aortic valve repair techniques have undergone significant refinement in the past decade. The basic tenets of valve repair are annular reduction (annuloplasty) and leaflet repair. These techniques results in reliable repair of many valves that are leaky (aortic regurgitation). This helps restore function of the valve while minimizing need for anticoagulation or risk of prosthetic valve degeneration.


Valve Sparing Root Replacement

Aneurysms of the aortic root (the first segment of the aorta adjacent to the heart) are complex due to the close proximity of the coronary arteries along with the aortic valve. Historically, the aortic valve would be replaced at the time of root replacement regardless of the function of the valve. Refinements in surgical techniques have allowed valve-sparing approaches (VSRR or David V operation) to be developed for the treatment of these complex aneurysms. The University is a high-volume center for VSRR, and many patients are eligible for this procedure (including those with bicuspid aortic valves or aortic regurgitation).

Ross Procedure

There are certain circumstances when the native aortic valve cannot be repaired, including when severe calcification or aortic stenosis is present. In certain patients, the Ross procedure is an excellent choice. The Ross procedure. [Reproduced with permission….]This involves moving the patient’s own pulmonary valve into the aortic position and then reconstructing the pulmonary valve with a cadaver valve. The Ross procedure has been shown to have excellent long-term outcomes and actually result in many patients going on to have a normal long-term life expectancy2. The Ross procedure is a complex operation and requires follow-up, and the team at the University of Washington has vast experience with this procedure.

Physician to Physician Conversation

Dr. Burke discusses Aortic Valve repair with Dr. Perry in AP Cardiology a Cardiology podcast for internists, residents and medical students. AP Cardiology Podcast. [Reproduced with permission….] The podcast that provides useful insights into the evaluation of aortic valve disease and what patients may be good candidates for repair. They discuss this in the relation to aortic valve replacement and the Ross procedure.

References

  1. Bouhout I, Stevens LM, Mazine A, Poirier N, Cartier R, Demers P, El-Hamamsy I. Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1341-1346.
  2. Mazine A, El-Hamamsy I, Verma S, Peterson MD, Bonow RO, Yacoub MH, David TE, Bhatt DL. Ross Procedure in Adults for Cardiologists and Cardiac Surgeons: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018 Dec 4;72(22):2761-2777