Open surgery aortic valve

Just as many patients are judged high risk for open-heart aortic valve repair/ replacement, many patients with functional or degenerative MV disease are unable to receive standard-of-care (on-pump open-heart surgery) treatment. Although MV replacement/implantation devices are widely under development, current options for high-risk patients are limited to MV repair techniques, such as the transfemoral MitraClip (Abbot Vascular Inc.) and the LV apical access NeoChord (NeoChord Inc.). 

Briefing Document for the Circulatory Systems Device Panel Advisory Committee, 2011, The Edwards SAPIEN THV transcatheter heart valve system for patients with severe aortic stenosis who are not candidates for conventional open-heart aortic valve replacement surgery. Food Drug Administration, p. 300. 

Valve Problems. The primary solution to valve problems has been implantable replacement valves. The introduction of these devices necessitates open-heart surgery. There are two types of valves available tissue (porcine and bovine) and mechanical. The disadvantage of tissue valves is that these have a limited life of about seven years before they calcify, stiffen, and have to be replaced. The mechanical valves can last a lifetime, but require anticoagulant therapy. In some patients, anticoagulants may not be feasible or may be contraindicated. Of the valves which require replacement, 99% are mitral and aortic valves. The valves on the left side of the heart are under much greater pressure because the left ventricle is pumping blood out to the entire body, instead of only to the lungs. Occasionally, two valves are replaced in the same procedure. 

Drogue, 1., and Villafana, M. 1997. ATS Medical open pivot valve. In Surgery for Acquired Aortic Valve Disease. Piwnica, A. and Westaby, S., Eds., ISIS Medical Media, Oxford, pp. 410-416. 

Katayama, S., et al. Bicnspid aortic valves undergo excessive strain during opening A simulation study. The Journal of Thoracic and Cardiovascular Surgery 145(6), 1570-1576 (2013)... 

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