Aortic valve replacement (AVR) surgery is performed for people with aortic stenosis or aortic regurgitation where the heart valve between the heart and the main artery in the body is either narrowed (aortic stenosis) or leaking (aortic regurgitation). A narrowed aortic valve carries a risk of premature death and symptoms include chest pain and dizziness. A leaking aortic valve causes the heart to fail with debilitating symptoms including breathless, fatigue and swollen ankles.
The aim of the operation is to replace the diseased valve with a new substitute valve. With a successful AVR operation, most patients can expect a marked improvement in quality of life as well as increased life expectancy. Mario Petrou is a specialist in aortic valve surgery and is Head of Program for Complex Aortic Surgery in Oxford. He consistently achieves a survival rate of over 99% for patients undergoing AVR - ?link to graph.
The operation can be performed through the breastbone (conventional median sternotomy) or through a mini incision (partial sternotomy). The recovery from either approach is usually excellent and most patients are discharged home within 5 or 6 days post-operatively.
Mario Petrou will discuss with you your choice of replacement valve. There are two main categories of artificial valves: mechanical metallic valves and animal valves. Mechanical heart valves are durable and minimise the chances of requiring a further operation. However, patients having mechanical valves are required to take life-long blood thinning drugs such as warfarin. Warfarin requires regular monitoring via blood tests and increases the risk of spontaneous bleeding. In addition, warfarin interacts with other drugs such as antibiotics and alcohol.
Animal valves are manufactured from bovine or porcine material. There is no requirement for lifelong blood thinning therapy with animal valves. They are, however, prone to wear and tear over the following decade or so. As a result, patients may require a re-operation at some point in the future. The general rule is that the younger the patient is at the time of their AVR the faster an animal valve will degenerate. In particular, adolescents, young adults (20-40 years) and women of child-bearing age might want to consider alternatives to these valve substitutes such as the Ross Procedure. Patients with aortic valve regurgitation may be suitable for repair of the aortic valve rather than replacement and Mario Petrou would be happy to discuss your suitability for this procedure.