Valve Prosthesis Flashcards
What marked the beginning of modern valve surgery?
The successful operation by Harken to remove foreign bodies from the heart after World War II
This led to further developments in correcting congenital defects and acquired valve disease.
What are the common pathologies that may necessitate intervention on the aortic valve?
Aortic stenosis, aortic insufficiency, and aneurysmal disease of the root and ascending aorta
What is the primary indication for aortic valve surgery in cases of aortic stenosis?
The presence of symptoms such as angina, syncope, or dyspnea on exertion
According to the 2014 AHA/ACC guidelines, what are the indications for aortic valve replacement in symptomatic patients with severe aortic stenosis?
Symptomatic patients with severe AS, symptomatic patients with low flow/low gradient severe AS, and asymptomatic patients with severe AS
List the common diseases leading to aortic regurgitation.
- Calcific degeneration
- Myxomatous degeneration
- Rheumatic disease
- Infective endocarditis
- Bicuspid aortic valves
What are the criteria for determining the severity of aortic stenosis?
Aortic valve area (AVA) and mean pressure gradient
Fill in the blank: Aortic stenosis is the most prevalent valvular heart disease in _______.
adults
What factors should be considered when planning for aortic valve replacement?
- Patient’s age
- Ability to tolerate long-term anticoagulation
- Aortic root size
What are the advantages of mechanical valves?
- Excellent durability
- Greater freedom from valve-related events
- Improved survival compared to biologic prosthesis
- Excellent hemodynamics
What is the primary disadvantage of mechanical valves?
The need for anticoagulation
What are bioprosthetic valves typically made from?
Bovine or porcine tissue
What is a significant advantage of bioprosthetic valves compared to mechanical valves?
Freedom from therapeutic anticoagulation
What are the indications for using homografts in valve replacement?
- Treatment of aortic valve endocarditis affecting the root
- Patients with a small aortic root
- Patients who cannot be anticoagulated
What is the Ross procedure?
Replacement of the diseased aortic valve with a pulmonary autograft and reconstruction of the right ventricular outflow tract with a homograft or xenograft
True or False: The Ross procedure requires long-term anticoagulation.
False
Who are ideal candidates for the Ross procedure?
- Young adults with aortic valve disease
- Women of childbearing age
- High-level athletes
- Patients with a life expectancy greater than 20 years
What is a common risk associated with mechanical valves?
Anticoagulation-related hemorrhage
What are the AHA/ACC guidelines for the severity of aortic regurgitation based on jet width?
- Mild: <25%
- Moderate: 25–64%
- Severe: ≥65%
What are the expected long-term outcomes for patients with mechanical valves?
Less than 2% valve replacement rate over 25 years
What is the risk of thromboembolism with mechanical valves?
0.8% to 2.3% per patient year when anticoagulated
What is structural valve deterioration (SVD) and how does it affect bioprosthetic valves?
SVD leads to higher reoperation rates and falls rapidly after 15 years of follow-up
What is the Ross procedure?
A surgical technique for aortic valve replacement using the patient’s own pulmonary valve
It converts a single valve pathology to a double-valve pathology, increasing reoperation rates.
What are the age considerations for the Ross procedure?
Safe for selected patients up to age 70, but not recommended for those with significantly reduced life expectancy beyond that age
Reports indicate excellent outcomes for both elderly and infants.
List contraindications to the Ross procedure.
- Multivessel coronary artery disease
- Severely depressed left ventricular function
- Multiple valvular pathology
- Disease of the native pulmonary valve
- Connective tissue disease
- Significant aortic root dilation
