There are two main conditions that can affect an aortic valve, aortic stenosis (AS) and aortic regurgitation (AR). These conditions are usually diagnosed by your internist by the detection of a heart murmur and followed by your cardiologist by periodic echocardiograms. Once these conditions become severe and/or symptomatic, in almost all cases surgery should be performed.
AHA/ACC 2014 Guidelines for the Management of Patients with Severe or Moderately Severe Aortic Stenosis
AHA/ACC 2014 Guidelines for the Management of Patients with Severe or Moderately Severe Aortic Regurgitation:
As you can see from these best treatment flow charts available online from the American Heart Association/ American College of Cardiology (click here to download the article), once AS or AR is severe and/or symptomatic, in almost all cases, best treatment usually indicates aortic valve replacement.
Traditional aortic valve replacement is performed through a 10 – 12 inch incision splitting the breastbone all the way. Mini AVR however can now be performed using only a 3 inch incision! Clinical studies have shown that Mini AVR is not only cosmetically more pleasing but also it’s associated with a lot less pain, less blood loss, less need for blood transfusions, better ability to breathe after surgery, earlier recovery, and a shorter hospital stay.
The Cleveland Clinic published a study comparing the results of Mini AVR vs. standard full sternotomy AVR:
Objective: Less invasive approaches to aortic valve surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods.
Methods: From January 1995 to January 2004, a total of 2689 patients underwent isolated aortic valve surgery, 1193 via upper J-hemisternotomy and 1496 via full sternotomy. Because of important differences in patient characteristics between these groups, a propensity score based on 42 variables was used to obtain 832 well-matched patient pairs (70% of possible cases).
Results: In-hospital mortality was identical for propensity-matched patients, 0.96 %( 8 in each). Occurrences of stroke (P>.9), renal failure (P = .8), and myocardial infarction (P = .7) were similar. However, 24-hour mediastinal drainage was a third less after less invasive surgery (median, 250 vs. 350 mL; P<.0001), and fewer patients received transfusions (24% vs. 34%; P <.0001). More patients undergoing less invasive surgery were extubated in the operating room (12%vs. 1.6%; P<.0001), postoperative forced 1-second expiratory volume was higher (P = .009), and fewer had respiratory failure (P = .01). Early after operation, pain scores were lower (P<.0001) after less-invasive surgery and postoperative length of stay shorter (P<.0001).
Conclusions: Within that portion of the spectrum of isolated aortic valve surgery where propensity matching was possible, minimally invasive aortic valve surgery had not only cosmetic advantages, but blood product use, respiratory, pain, and resource utilization advantages over full sternotomy, and no apparent detriments. Less invasive aortic valve surgery should be considered for most aortic valve operations. (J Thorac Cardiovasc Surg 2012; 144:852-8)..
(You can download this article by clicking here)
Who is a candidate for Mini AVR?
Almost everyone! If you need an Aortic Valve Replacement, you are probably a candidate for this minimally invasive procedure. We would welcome seeing you in our office in consultation. We believe you will be glad you came!