Type of Surgery
Information
Last updated: 11/24/2009
While receiving general anesthesia in preparation for the surgery, the patient's cardiac function will be monitored. A sternotomy (incision in the sternum) or thoracotomy may be used to expose the heart, with the thoracotomy providing...
a smaller incision through the ribs. Anticoagulant is administered in preparation for cardiopulmonary bypass. Cardiopulmonary bypass is instituted by exposing and cannulating (putting tubes in) the great blood vessels of the heart, or by cannulating the
femoral artery and vein. A combination of cannulation sites may also be used. The heart is stopped after the aorta is clamped. The aortic root is opened and the diseased valve is removed. Sutures are placed in the aortic rim and into the replacement valve. The replacement valve can be either mechanical or biological tissue. The replacement valve will be sized prior to implant to ensure that it fits the patient based on the size of the aortic valve annulus. Once seated, the valve is secured by tying the individual sutures. The heart is then deaired. The cross clamp is removed and the heart is allowed to beat as deairing continues by manipulation of the left ventricle. Cardiopulmonary bypass is terminated, the tubes are removed and drugs to reverse anticoagulation are administered.
A heart valve is an orifice that blood passes through in systole, and it is also an occluding (blocking) mechanism necessary to prevent the flow of blood during diastole. Heart valves can be mechanical or biological tissue valves. For patients younger then 65 years of age, the mechanical valve offers superior longevity. Anticoagulation is required for the life of the patient implanted with a mechanical valve. The biological tissue valve does not require anticoagulation but suffers from deterioration, leading to reoperation particularly in those under age 50. Women considering bearing children should be treated with biological tissue valves as the anticoagulant of choice with mechanical valves, warfarin, is associated with teterogenic effects in the fetus. Aspirin can be substituted in certain circumstances.
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Tiny electric currents flow through the heart muscle and cause them to contract, squeezing blood throughout the body. This animation shows the electrical system of the heart and how it is driven by a small patch of tissue called the cardiac pacemaker or sinoatrial node.
The heart is accessed through a chest incision (A). The patient's heart function is replaced by the heart-lung machine. The aorta is cut open to reveal a diseased aortic valve (B), which is then removed. A valve sizer is placed in the opening to determine the size of prosthesis needed (C). A prosthetic valve is sutured in place (D and E). (Illustration by Argosy.)
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Other Information
Aortic valve replacement is a cardiac surgery procedure in which a patient's aortic valve is replaced by a different valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency / regurgitation) or partially blocked (aortic stenosis). Aortic valve replacement currently requires open heart surgery.
Other Information
Traditional Coronary Artery Bypass Graft (CABG) surgery has undesirable side effects that range from cognitive loss to increased hospital stays that are believed to be related to artificial heart pumps. In this project, we believe that if the heart were able to beat freely during surgery, these pumps would not be needed and it is possible that these side effects might be lessened.
-M. Cenk Cavusoglu
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