2 The condition, current treatments and procedure
Aortic valve disease (stenosis or regurgitation) is usually progressive and causes an increase in cardiac workload, left ventricular hypertrophy and heart failure. Symptoms can include palpitations, fatigue, shortness of breath and chest pain on exertion. Mortality rates are high in symptomatic patients.
2.1 Conventional treatment for a significantly diseased aortic valve is surgical replacement with an artificial (biological or mechanical) prosthesis. Transcatheter aortic valve implantation may also be considered. Bioprosthetic valves do not perform as well as native valves and have limited durability, which may be an issue for younger patients. Lifelong anticoagulation is needed in patients with mechanical valves, which increases the risk of haemorrhagic complications and is not optimal in women wishing to become pregnant. In some patients with aortic regurgitation, the aortic valve may be repaired with patches as an alternative to replacement.
2.2 Aortic valve reconstruction with bovine pericardium may be considered in patients who cannot or who refuse to take anticoagulation, patients with an aorta too narrow for a standard prosthetic valve and young patients who wish to avoid long-term anticoagulation.
2.3 With the patient under general anaesthesia, the heart is accessed by a sternotomy and cardiopulmonary bypass is established. The heart is stopped with cardioplegic arrest, the aorta is opened and the valve is inspected. The diseased valve cusps are carefully removed and the intercommissural distances are measured. Commercially available bovine pericardium is trimmed to the desired size using a template, and sutured to the annulus to replace the removed cusp(s). The aorta is closed, normal circulation is restored and the chest is closed. The function of the valve is assessed intraoperatively by transoesophageal echocardiography.