The two main groups of diseases which are indications for aortic valve replacement are severe aortic stenosis (significant valve narrowing) and severe aortic insufficiency (significant valve failure).
Aortic stenosis
It is the most common disease of this valve and occurs in middle and old age. Narrowed valve opening makes blood flow, i.e. blood pumping difficult which results in putting additional stress on the heart. Patients with aortic stenosis remain asymptomatic for a long period of time. The occurrence of angina symptoms, mild loss of consciousness (syncope) or heart failure (easy fatigue and heavy breathing) along with the presence of heart murmurs are symptoms of this disease. It should be emphasized that in about 50% of patients, the death outcome occurs in 2 to 5 years on the average after the appearance of symptoms, if the diseases is not treated surgically! Surgical treatment of severe aortic stenosis is also necessary in patients who do not have obvious difficulties, but in which the ultrasound examination confirms that the disease leads to heart damage.
Aortic insufficiency (regurgitation)
Aortic valve regurgitation is an aortic valve disease which does not allow the diseased aortic valve to close thus causing the blood from the aorta to return to the heart and put additional stress on it. Aortic regurgitation should be operated on before the heart function is impaired. Surgical treatment, which includes replacement or reconstruction, is the definitive treatment. The most common method of surgical treatment is aortic valve replacement. In this case, the diseased valve is completely removed and mechanical or biological protection (valve) is installed. The advantage of the mechanical prosthesis lies in the fact that it is long-lasting, whereas its disadvantage is reflected in the necessity of taking anticoagulant therapies (against blood clotting). Patients under the age of 65 usually have a mechanical valve implanted, since the biological valve decays faster in these patients. In case of the elderly, the implantation of biological prosthesis is indicated since it does not require long-term use of anticoagulant therapy.
A less or minimally invasive surgical approach to the aortic valve treatment is more often used. This implies small incisions in the skin and minor surgical trauma. This means that in case of “ministerotomy” only the upper half of the sternum is cut, whereas in case of anterior tocarcotomy the valve is accessed through the 2 nd intercostal space. Of course, median sternotomy (an incision is made along the entire length of the sternum) remains as the standard approach, especially when it comes to combined surgery (bypass surgery or surgery on the second valve).
