Royal North Shore Hospital
North Shore Private Hospital
Suite 3.04 Level 3
North Shore Health Hub
7 Westbourne Street
St Leonards NSW 2065
P: 02 9449 1559
F: 02 9185 3559
The aorta is the main artery which transports all of the blood from the heart and distributes it throughout the body. The aortic valve is situated at the base of the aorta and controls the flow of blood out of the heart. Surgery is required if the aortic valve fails to open (aortic stenosis) or close properly (aortic regurgitation), or if the aorta is enlarged (aortic aneurysm).
Patients with aortic valve dysfunction who are experiencing symptoms of shortness of breath, dizzy spells or chest discomfort (angina) should undergo valve replacement to improve their survival and to alleviate their symptoms. Some patients may be candidates for this procedure to be performed minimally invasively which can offer less pain and a faster recovery for the patient.
TAVI is reserved for patients that are too high risk for open or minimally invasive surgery and this is because we don’t yet know the long-term results of this relatively new procedure.
The patient would need an open valve replacement if they also require surgery to their mitral or tricuspid valve. Additionally, open surgery would be the best option for patients who have any blocked arteries which require bypass surgery, any previous heart surgery or a dilated aorta (anuerysm).
The faulty valve is replaced with an artificial valve from these two broad categories: tissue valves and mechanical valves.
Generally, patients under the age of 60 will choose a mechanical valve and patients older than 65 will choose a tissue valve due to the differences in longevity of the valves and the need to be on blood thinners. In younger patients, tissue valves are found to be less durable for reasons that aren’t completely clear but may relate to their stronger immune system. When the valve fails a repeat surgery is generally required to place a new valve.
With newer technologies emerging we can now replace the deteriorated valve via catheter techniques and avoid surgery completely, however not all patients are suited to this new technology and each patient has to be assessed individually for suitability.
A tissue valve is made from cow or pig material. This type of valve is usually more suitable for patients over the age of 65 as it lasts for approximately 10 years before needing a replacement and redo valve surgery. There is also no long-term requirements for the patient to take blood thinners.
A mechanical valve is sometimes referred to as a metal valve, but is actually constructed from pyrolytic carbon. This valve more suitable for patients under the ago of 60, as they can last forever and don’t need a redo operation. The patient will need to take the blood thinner ‘warfarin’ to ensure the valve functions properly.