Valve Replacements and Cardiac Surgery

Indications for Valve Replacements

  • Severe valve stenosis or regurgitation causing symptoms, heart failure, or ventricular dysfunction.
  • Conditions such as aortic stenosis, mitral regurgitation, and endocarditis-associated valve damage.

Types of Valve Replacements

  • Open valve replacement (invasive): Traditional method requiring sternotomy.
  • Transcatheter Aortic Valve Implantation (TAVI) (non-invasive): For patients with high surgical risk, used mainly for aortic valve replacement.
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The World’s First Valve Replacement: The first successful heart valve replacement was performed in 1960 by Dr. Albert Starr and engineer Lowell Edwards, who designed the first ball-and-cage valve. This early mechanical valve design revolutionised heart surgery, and Dr. Starr’s patient lived for over 10 years post-surgery—an astonishing outcome for the time.

Valve Types

  • Metallic valves:
    • Advantages: Durability (lasts longer, especially in younger patients).
    • Disadvantages: Requires lifelong anticoagulation (INR target for aortic valve: 2.0-3.0; for mitral valve: 2.5-3.5 due to higher thrombotic risk).
  • Tissue valves:
    • Advantages: No need for long-term anticoagulation.
    • Disadvantages: Less durable (lasts 10-15 years).
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In younger patients, the Ross procedure is a unique type of valve replacement where the patient's own pulmonary valveis used to replace the diseased aortic valve. A donor valve is then used to replace the patient’s pulmonary valve. This is an excellent option because the patient's native valve typically grows with them, making it particularly beneficial for children and young adults.

Common Cardiac Surgeries Involving Midline Sternotomy

  • Coronary artery bypass grafting (CABG).
  • Valve replacements/repairs (aortic or mitral).
  • Heart ± lung transplant
  • Aortic aneurysm repairs.