When aortic valve disease causes symptoms in adults, valve replacement surgery can fix the problem. But – even better – there’s a way to keep your valve and relieve your symptoms, too.
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A recent study looked at results from surgeries to repair valves instead of replacing them. The study found that valve repair produced excellent outcomes for middle-aged bicuspid aortic valve (BAV) disease patients who had leaky heart valves.
Valve repair provided a safe and lasting fix. It also avoided the lifelong need to take blood thinners that follows valve replacement surgery.
Signs of defect show up in your 30s or 40s
BAV is the most common congenital (present at birth) type of heart defect. However, most people who have congenital aortic valve defects don’t develop symptoms until they are in their 30s or 40s.
Many people with valve defects never require treatment. However, for some people, the leaky, defective valves eventually allow blood to regurgitate, or flow backwards into the heart. This causes shortness of breath and stresses the heart.
Study reviews aortic valve repair results
Lars Svensson, MD, PhD, Chairman of Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute, headed up the BAV study. It looked at 728 patients who underwent aortic valve repair for BAV disease at Cleveland Clinic from 1985 to 2011.
Of these patients, 70 percent had blood flowing backwards because of the faulty valve.
Outcomes were excellent (94 percent survival after 10 years). Almost 80 percent of patients needed no follow-up procedures.
“Our results show that bicuspid aortic valve repair can be achieved with low risk,” says Dr. Svensson. “Life expectancy for these patients is excellent.”
Risk of complications following surgery, such as endocarditis (infection of the heart valves or inner lining of the heart) and uncontrolled bleeding, was very low, as was risk of stroke (0.27 percent – perioperative). Long-term risk of stroke is also very rare.
The study found risk of death for a first operation was only .41 percent and no deaths after a re-operation.
Surgeons make other repairs at the same time
BAV can occur along with other complications such as aneurysms, or abnormal weakness and bulges in the ascending aorta.
When surgeons repaired these problems at the same time as the valve work, patients were more likely to remain symptom free and require fewer additional procedures.
“We believe that some larger aortic aneurysms should be fixed at the time of valve repair. It increases the lasting benefits for patients to do both procedures at once,” says Dr. Svensson.
Minimally invasive technique offers quick recovery
Experienced surgical teams and cardiac centers specialize in repairing bicuspid aortic valves with a minimally invasive “keyhole” operation.
Patients can go home four to seven days after surgery and can return to driving – and often to work – in as little as two weeks.
Study finds surgery results successful, durable
Results of the Cleveland Clinic study, published in the May 2014 Annals of Thoracic Surgery, confirm the durability of valve repair surgery. Ten years after repair, 91 percent of patients still had their own valve.
Eventually, some patients will need valve replacement surgery to treat advancing BAV disease. However, minimally invasive surgery can delay that day – even for decades in many cases.
“Many will probably need a replacement later, maybe 20 years after surgery, but repair enables us to hold it off,” says Dr. Svensson. “Most of these patients are young at the time of repair, so we were able to spare them from being on Coumadin® for life,” he says.