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Aortic Valve Replacement – AVR

Surgical Aortic Valve Replacement (SAVR)

The aortic valve sits between the heart (left ventricle) and the aorta (a major vessel that carries blood throughout the body). A faulty aortic valve is almost always replaced by a prosthesis. It can be repaired in rare and specific circumstances. Indications for Surgical Aortic Valve Replacement (SAVR) follows complex guidelines, summarized as:

  • In isolation, when there is severe damage to the valve, either obstruction (also called ‘stenosis’) or leakage (‘regurgitation’ or ‘insufficiency’)
  • When there is moderate damage to the valve and combined cardiac surgery is necessary (e.g. CABG, repair of aneurysm in the ascending aorta)
  • Infection of the aortic valve

NOTE: Any artificial heart valve will obstruct and leak a little bit, which can cause a murmur. Native valves are haemodynamically perfect: no leak, no obstruction and no murmur.

The Surgery

Conventionally, the heart is accessed via a vertical incision over the breastbone (called ‘sternum’). Cardiopulmonary Bypass and cardiac preservation are then established.

The aorta is opened and the native aortic valve is removed with extreme care to clean all debris. The aortic valve prosthesis is then stitched to the heart. The aorta is closed and air is evacuated from the heart.

The blood supply to the heart is resumed and it starts to beat again. Sometimes, a small electric shock is used to re-establish normal rhythm. Finally, the heart takes over the circulation again and the heart-lung machine is disconnected.

Afterwards, the surgeon controls potential sites of bleeding and inserts chest drains. A temporary pacemaker wire is also inserted. Drains and wires are removed in ICU or ward when no longer required.

The breastbone is closed with stainless steel wires. They will remain in your bone and should not activate metal detectors.

Choice of Prosthetic Valve

In a nutshell, there are 2 types of heart valve substitutes: tissue and mechanical prosthesis.

Mechanical valves don’t wear off, but require continuous and lifelong blood thinning with vitamin K antagonist (VKA), for example Warfarin, Marevan or Coumadin. VKA carries a yearly complication rate of about 1 to 2% per year. Need for re-operation of a mechanical valve is low, however the risk still exists.

Tissue valves do not necessarily need continuous blood thinning, but wear off over time and will require replacement.

The valve preference is individual. However, patient’s specific situations should be discussed with the surgeon so that a shared decision-making about the choice of valve type is achieved. This choice is influenced by several factors, including patient age, values, and preferences; expected bioprosthetic valve durability, avoidance of patient-prosthesis mismatch (when the size of the vale is too small for the size of the patient), and the potential need for and timing of re-intervention; and the risks associated with long-term VKA anticoagulation after a mechanical valve replacement. Read more.

Alternatives to Conventional SAVR

Minimal Access SAVR

Minimal Access SAVR is performed via a smaller chest incision (skin and bone) and sometimes a series of holes on the chest to support other instruments. The circulatory support by the heart-lung-machine is carried on via cannulation of the groin and/or neck vessels. It is not suitable to every patient.

Transcutaneous Aortic Valve Implantation – TAVI

For information about TAVI, please click here.

Ross Procedure

In the Ross Procedure, the aortic valve is replaced by the patient’s own pulmonary valve. This means that the pulmonary vale has to be removed from the heart, inserted in the aortic position and another valve has to be used in the pulmonary position. It is a very complex surgery reserved for young patients and performed by only small number of surgeons in Australia.

Commonly Associated Procedures with SAVR

Coronary Artery Bypass, Mitral Valve Surgery, Myectomy and Tricuspid Valve Surgery.

Associated Risks

Cardiac surgery is routinely performed all over the world. Australia ranks very well internationally, reflecting a high standard of care from both the operative setup and the hospital systems. As with any medical procedure, in a small number of cases, complications (adverse events) may occur.

The 5 major risks are bleeding and blood transfusion, mediastinitis (infection deeper to the chest bone), heart attack, stroke and even death. Other risks include need for pacemaker and organ failure (e.g. heart, lungs, kidneys).

The risk of infections, heart and lung problems and thrombosis increases with diabetes, obesity and smoking.

Please speak to your surgeon regarding your individual circumstances and any questions or doubts you may have.

For information about associated risks of cardiac surgery, please click here.


For an appointment or seeking a second opinion with Dr Provenzano, please contact:

Gold Coast Private Specialist Suites 14 Hill Street, Southport

P: (07) 5699 8258   F: (07) 5676 6784

Dr Sylvio Provenzano

MD, MSc, FRACS


Dr Sylvio Provenzano is an exam-qualified Cardiothoracic Surgeon by the Royal Australasian College of Surgeons (RACS). He specialises in cardiac, thoracic and congenital cardiac surgery.

Opening Hours

Gold Coast Private Specialist Suites


14 Hill Street, Southport 4215
9:00 – 16:00
 
Phone: (07) 5699 8258
Fax: (07) 5676 6784
 
Correspondence:
PO Box 809, Southport BC, Qld 4215