When is Aortic Valve Replacement Surgery required?
Aortic valve can be damaged by various diseases and can cause leakage (aortic insufficiency) or partial blockage (aortic stenosis). Damage from endocarditis (infection) might also lead to damage of valve.The aortic valve replacement surgery is conducted to replace the defected aortic valve with an artificial one. If left untreated, the most common problem that arises is an enlarged heart muscle which often leads to heart failure.
Different methods to perform Aortic Valve replacement
The surgery is often conducted in two commonly practiced ways:
- In the conventional open heart surgery, the surgeon makes a large incision and a heart-lung machine is made usage of to circulate the blood outside the body for providing oxygen to it. The incision might be six to ten inches deep and is down from the centre of the sternum. The heart might then be cooled to slow the beating process. This protects the heart from further damage and an artificial valve is placed for regulating normal blood flow.
- In the minimally invasive technique, small incisions are done between two to four inches using specialized surgical instruments. The recovery period is also shorter.
- Transcatheter aortic valve surgery, often done using minimally invasive technique is another method which assures long term survival and has created a benchmark in the development of cardiac science technologies.
How it is done?
If the aortic valve replacement process takes place through the minimally invasive technique then it can be done through various ways like mini- thoracotomy or steronotomy, percutaneous surgery and robot assisted surgery. The surgeon makes an incision about 2-3 inches deep in the right region of the sternum to reach the affected region.
For robotically assisted surgery, 2 to 4 tiny cuts are made in the chest and the surgeon uses a computer to control the entire operation. The surgeon replaces the damaged valve with a new artificial one. Coronary artery bypass surgery ( CABG) is sometimes used to replace the part of the affected aorta.
Implants used in aortic valve replacement
According to a patient’s requirement, the choice of valve depends. The valves are considered on the basis of their durability and the risks associated with it. The commonly used ones are:
- Manufactured Mechanical Valve – Composed of strong, durable metals, they are long lasting and tend to last throughout the patient’s life. However, patients need blood thinning medication on the usage of this valve as it causes clotting and can lead to problems like heart attack or stroke.
- Donor valve implantation- This is the least commonly used valve with a lasting capacity of 10-20 years. It is used for patients suffering from infective endocarditis.
- Tissue or Bioprosthetic valve- Lasting for about 10- 20 years, these valves are composed of animal tissues and are strong and flexible. Using tissue valve for a patient. Makes him/her less likely to undergo an operation later in life.
Precautions / Points to remember
During the post operative period, the patient is advised by the doctor to keep certain health related aspects in mind.
- The patient should not indulge in strenuous exercise but should practice breathing exercises.
- Eating a healthy, low- salt diet is recommended.
- The incision should be taken proper care and the area should be kept clean and dry.
- Regular checkups are necessary to trace the recovery.
Success rate of Aortic Valve Replacement Surgery
The aortic valve replacement surgery is often considered safe and occurrences of death or serious health complications are rare. Long term survival is often derived out of findings, where patients undergoing aortic valve replacement surgery live upto an average of 65 years. In elderly patients, excellent short and mid -term results are assured in surgical aortic valve replacement. Transcatheter aortic valve surgery is a safe remedial option for patients having severe heart complexities.
Aortic Valve Replacement cost in India?
The cardiac surgical cost in India is comparatively lower by 60% of what a patient spends for the same treatment in the western countries. The valve replacement cost generally commences from $6245.The open heart surgery cost varies from that of the minimally invasive approach. The treatment price also varies with the following factors: the age of the patient, the technique used and also differs from one city to another. Besides the treatment provided by the private hospitals across India, cheap and effective treatment is rendered by some Government hospitals like AIIMS, Safdarjung Hospital and National Heart Institute all located in Delhi and others.
Top Indian hospitals for the valve replacement surgery
The hospitals that are widely recommended across India for successful aortic valve repair surgeries with an affordable treatment package are as follows:
- Fortis Escorts, New Delhi
- Apollo groups (Bangalore, Chennai, Hyderabad)
- Apollo Indraprastha, New Delhi
- BLK super Speciality Hospital, Delhi
- Wockhardt Hospital, South Mumbai
- Nanavati Super Speciality Hospital
- Narayana Institute of Cardiac Science
- BGS Global Hospital, Bangalore
- Kokilaben Dhirubhai Ambani Hospital, Mumbai
- Artemis Hospital, Gurgaon.
- Medanta-The Medicity, Gurgaon.
Best valve replacement surgeons in India
In India, we have proficient surgeons and cardiologists possessing years of experience and thorough knowledge on different heart complications. They provide effective and multidisciplinary remedial treatment as per the patient’s requirement. The most distinguished cardiac surgeons for aortic valve replacement surgery are:
- Dr. Naresh Trehan ( Medanta Medicity, Gurgaon )
- Dr. Devi Prasad Shetty (Narayana Institue of Cardiac Science, Bangalore)
- Dr. Mahadev D Dixit (CMI Hospital, Bangalore)
- Dr. Vivek Jawali (Fortis Hospital, Cunningham Road)
- Dr, Ramakanta Panda (Asian Heart Institute, Mumbai)
- Dr. Mukundan Seshadri (Columbia Asia Referral Hospital, Malleshwaram)
- Dr. KR Balakrishnan ( Fortis Malar Hospital, Chennai)
- Dr. Sathyaki P Nambala ( ApolloCollins Hospitals, Banerghatta Road)
Some patients have shared their medical experiences in India.
- 74 Year old, Redda Teklehaimanot Zewdu suffered from calcified aortic stenosis. Nandikishore Kapadia of Kokilaben Dhirubhai Ambani Hospital, Mumbai, after going through his medical reports and examining his physical condition suggested a valve replacement surgery along with CABG treatment. The doctor said that due to the accumulation of excessive calcium in the aortic valve, the blood flow has got restricted and that has caused chest pain and associated discomfort in Mr. Zewdu.
After the surgery was completed, Mr. Zewdu felt a lot better though he suffered from pre surgery jitters. Though he underwent a major CABG surgery yet the process was smooth and flawlessly conducted by the doctor. He says that he felt no post surgery discomfort or acute pain. His stay at the hospital was a comfortable one and the medical staff offered proper remedial care to him, aiding in his fast recovery. He was advised regular checkups with the doctor and thus his entire experience with the hospital was really satisfactory. The treatment provided to him was really effective and budget friendly and brought about a beneficial change to his physical health.
- Leah Gathoni Kariuki from Kenya was really worried about her 2 year old daughter, Portia who suffered from a congenital heart disorder. Portia’s tricuspid valves were weak thus resulting in her frequent exhaustion. A surgery was required to cure the defect and prevent further damage to the heart.
Mrs. Karuiki after seeking proper knowledge about the successful cardiac surgeries done in India, got in touch with Medanta-the Medicity in Gurgaon. Dr. Amit Misri was consulted and Mrs. Karuiki says that “He recommended us to a senior cardiothoracic surgeon in the hospital, Dr. Anil Bhan. Although Dr. Bhan suggested a valve repair surgery, he also said a proper medical management would cure her as well.” But Portia’s mother gave her consent for surgery before her daughter’s health starts to deteriorate.
Accordingly, the doctor conducted an open heart surgery to repair her tricuspid valve defect. However, during the surgery the medical team realized that the condition of Portia’s heart had worsened which compelled them to perform a valve replacement surgery. Mrs. Karuiki observes “I am happy and relieved that the surgery is successful and her recovery has been stable.” She is happy with the effort and dedication of the doctors and Portia recovered within ten days with no further health complications.