How Is An Aortic Valve Replacement Carried Out
An aortic valve replacement is carried out under general anaesthetic.
This means you’ll be asleep during the operation and won’t feel any pain while it’s carried out.
During the procedure:
- a large cut about 25cm long is made in your chest to access your heart although sometimes a smaller cut may be made
- your heart is stopped and a heart-lung machine is used to take over the job of your heart during the operation
- the damaged or faulty valve is removed and replaced with the new one
- your heart is restarted and the opening in your chest is closed
The operation usually takes a few hours.
You’ll have a discussion with your doctor or surgeon before the procedure to decide whether a synthetic or animal tissue replacement valve is most suitable for you.
When Do You Need Heart Valve Replacement Surgery
A heart valve disease develops when the valve becomes either stiff, narrow , or leaky . These two disease states of the valve disrupt the flow of blood in and out of the heart.
Heart valve diseases can be present by birth or occur as a complication of other health conditions, such as rheumatic heart disease.
Many people who have heart valve disease may never experience any symptoms. Sometimes, the valve disease is diagnosed when a woman is pregnant. Doctors may still recommend heart valve replacement surgery to prevent the worsening of the heart condition.
With a diseased valve, heart valve replacement surgery becomes an emergency if you experience:
Outcomes After Avr In Patients Aged 80 And More
There are studies reporting good outcomes after AVR in the elderly. Gehlot et al. studied 322 patients with a mean age of 82.2 years who underwent AVR. On multivariate analysis, the most important independent predictors of mortality included female gender, renal impairment, EF 35%, bypass grafting and chronic obstructive pulmonary disease. Age and year of operation did not influence mortality. Five-year survival rates for all patients and for operative survivors were 60.2 ± 3.2% and 70.3 ± 3.4%. Asimakopoulos et al. reported on data collected from 1100 patients > 80 years undergoing AVR from the UK Heart Valve Registry. Actuarial survival rates were 89, 79, 69% and 46% at 1, 3, 5 and 8 years, respectively. Survival in the operated patients in our series was practically identical to this. Sundt et al. retrospectively evaluated 133 patients between the age of 80 and 91 years undergoing AVR. Actuarial survival rates at 1 and 5 years were 80 and 55%, respectively. Urgent or emergent surgery, aortic insufficiency, perioperative stroke or renal dysfunction were significant risk factors for operative death by multivariate analysis.
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Data Abstraction And Quality Assessment
In general, two reviewers independently extracted the study information, including study author, publication year, study period and design, location, inclusion criteria of age, sample size, follow-up duration, and patients characteristics. Early outcomes in this meta-analysis were 30-day mortality, duration of postoperative hospital stay, and postoperative complications. Late outcomes included 1- and 5-year survival and reoperation during follow-up. Methodological quality of included studies was evaluated using Newcastle-Ottawa Scale , with the following three main aspects: study group selection, comparability between groups, and ascertainment of outcomes . A study with a NOS score of 7 or higher was regarded as of high quality. Any disagreements in data collection and quality evaluation were settled by consensus between the two reviewers or discussion with a third reviewer .
Life Expectancy After Surgical Aortic Valve Replacement
Original Investigation
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
University of Oslo, Oslo, Norway
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cardiac Surgery In The Very Elderly: It Isnt All About Survival
Post-CCT Clinical Fellow in Cardiac Surgery
Simon Kendall Consultant Cardiac Surgeon and President Elect SCTS
Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW
Correspondence to:
Cardiac surgery for adults became widely available around 50 years ago, due mainly to the introduction of relatively safe cardiopulmonary bypass. Initially, mortality rates were quite high, even for relatively young and fit patients, and, therefore, patients and carers focused on this outcome measure. Moreover, it was easy to define and record. Local and national registries developed into databases that allowed comparison of mortality rates and were then further refined with risk modelling.
As the odds of survival after cardiac surgery improved, sicker and older patients were offered cardiac surgery, including octogenarians and extending to nonagenarians.
Clearly, surviving cardiac surgery is very important but is survival the top priority for the 92-year old after bypass surgery who becomes unable to live independently again and whos quality of life is insufferable? Should quality of life be the main factor driving therapeutic decisions for the frail and elderly?
Strengths Of Our Study
Ours is the largest study addressing this issue, and our patients are well characterized in terms of clinical, pharmacologic and echocardiographic data. We used robust statistical tools like propensity score analysis and sensitivity analysis in addition to the standard KaplanMeier analysis. Propensity score analysis was used to correct covariate imbalances. Modeling based on propensity scores is estimated to remove up to 90% of inherent bias of a retrospective study . Propensity score analysis reveals strong survival benefit with AVR in octogenarians with severe AS. As there is a nonproportionate mortality hazard during the first 30 days, sensitivity analysis was carried out to serially eliminate these initial observations and determine the survival benefit of AVR. By serial elimination of observations before 30 days, 90 days, 1 year and 2 years, AVR continues to show a very strong survival benefit.
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Use Of Surgical Risk Scores In The Decision Between Savr And Tavi
Surgical risk has been the key inclusion criterion in the landmark randomized studies that have compared the safety and efficacy of SAVR vs TAVI in patients with severe aortic stenosis. The first randomized studies between SAVR and TAVI were performed in patients with high surgical risk, defined as an STS-PROM score > 10% or based on an estimation of 30-day mortality risk > 15% by a Heart Team before surgery . The trials in high-risk patients were followed by randomized trials comparing SAVR and TAVI in patients with intermediate-risk using an STS-PROM score of 4%-8% or 3%-15% . Finally, recent low-risk trials have used either a < 3% 30-day mortality risk, as estimated by the local Heart Team , or an STS-PROM score of < 4% .
What Is The Success Rate Of Heart Valve Replacement Surgery
The success rate of heart valve surgery usually depends on various factors like the patients overall health, age and so on. Damage in the heart valve is primarily a serious condition and should be treated without much delay. Replacement surgery of the heart valve definitely increases the life expectancy of the patient, improving quality of life. Due to the advances in the medical field and use of latest technologies and heart care facilities, doctors have reported a success rate of around 94 to 97 percent of such a surgery. The mortality rate due to the heart valve replacement surgery has also decreased over the years of advancement.
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Mitral Valve Repair Versus Replacement In Elderly Patients: A Systematic Review And Meta
Xiaoke Shang1*, Rong Lu2*, Mei Liu2, Shuna Xiao3, Nianguo Dong1
1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , 2Department of Intensive Care Unit, Wuhan No. 1 Hospital Hubei Maternal and Child Health Hospital , , China
Contributions: Conception and design: N Dong Administrative support: N Dong Provision of study materials or patients: X Shang, R Lu Collection and assembly of data: X Shang, R Lu Data analysis and interpretation: X Shang, R Lu Manuscript writing: All authors Final approval of manuscript: All authors.
*These authors contributed equally to this work.
Correspondence to:
Background: Although mitral valve repair is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement . We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population.
Methods: We systematically searched PubMed, the Cochrane Library, and Scopus up to February 2017 and scrutinized the references of relevant literatures. Only studies of MVP vs. MVR in the elderly patients that were published after 2000 were included.
The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.
doi: 10.21037/jtd.2017.08.43
What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
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Sensitivity Analysis And Publication Bias
Exclusion of each study in sequence had no influence on the overall results of 30-day mortality, duration of postoperative hospital stay, and 1- and 5-year survivals. The funnel plots for 30-day mortality and duration of postoperative hospital stay were visually symmetrical with P values of Eggers test =0.20 and 0.38, respectively, suggesting the absence of publications bias. For other outcomes, publication bias test was not performed due to the limited number of included studies.
Figure S4
What Did This Study Do
This systematic review identified 93 observational studies including a total 53,884 adults undergoing bioprosthetic aortic valve replacement for severe aortic stenosis. Only studies published after 2006 were included to ensure relevance to current technologies. Patients were enrolled between 1977 and 2013. Average patient age was 53 to 92 years.
The researchers carried out several subgroups analyses to examine the influence of different factors. These included patient age, whether the study also included mechanical valves, and risk of study bias.
Overall the risk of bias was assessed as low in 51 studies, moderate for 21, and high risk for 21 studies.
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Alternatives To An Aortic Valve Replacement
An aortic valve replacement is the most effective treatment for aortic valve conditions.
Alternative procedures are usually only used if open heart surgery is too risky.
Possible alternatives include:
- transcatheter aortic valve implantation the replacement valve is guided into place through the blood vessels, rather than through a large incision in the chest
- aortic valve balloon valvuloplasty the valve is widened using a balloon
- sutureless aortic valve replacement the valve is not secured using stitches to minimise the time spent on a heart-lung machine
Page last reviewed: 23 December 2021 Next review due: 23 December 2024
Survival Time In Relation To Surgical Risk
The 30-day mortality for the entire cohort was 2.0% , 1.2% for low-risk, 4.1% for intermediate-risk, and 8.3% for high-risk patients .
Low-risk patients had a median survival time of 10.9 years , intermediate-risk patients of 7.3 years , and high-risk patients of 5.8 years . The continuous survival time for the 3 risk groups is illustrated in . The cumulative 5-year mortality of patients classified as low risk was 16.5% , for those classified as intermediate-risk, 30.7% , and for patients classified as high-risk, 43.0% . The 10-year cumulative mortality is depicted in . The sensitivity analysis, with imputed EuroSCORE values for patients with missing risk assessment, confirmed the results of the primary analysis .
Figure 2
Smoothed Line Plot of Survival Time Based on Age at Operation
The median survival time as a function of age for low-, intermediate-, and high-risk patients. As is illustrated, older age had a substantial impact on median survival for patients in the low-risk group but the impact was attenuated for intermediate- and high-risk patients.
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Other Frequently Asked Questions
- Is there such a thing as too old? What about aortic valve replacement in a 90-year-old? Ultimately, theres two people who matter when making this decision: the senior and their doctor. There are risks associated with any medical procedure, but you may decide that the cost of inaction outweighs the risks.
- If I had heart valve replacement at 65, will I need another later? Possibly, depending on a number of factors, including the health of your other valves at the time. Its not uncommon for those with heart valve issues to live long lives with the help of modern medicine, nutrition and fitness.
Survival Rate Of Heart Valve Replacement Surgery
The survival rate for a heart valve replacement surgery depends on which valve is involved. This was analyzed in a large study in which the lifespan of a large population, who went ahead with the surgery, is observed for a specific timeframe.
The 5-year survival rate means what percentage of people lived for at least 5 years after the surgery. Similarly, the 10-year survival rate means what percentage of people lived for at least 10 years after the surgery.
For example, the 5-year survival rates for aortic valve replacement surgery is 94%. This means 94 out of 100 people who underwent AVR surgery could live at least 5 years.
Table 1: The Survival Rates as Per the Type of Valve in Heart Valve Replacement Surgeries
Survival rates for heart valve replacement surgery are often used as predictors of how long patients can live beyond a certain number of years after the surgery. However, these may vary for you depending on your age, your overall health, and the current status of your heart function. Discuss with your doctor about these factors to know about your life expectancy after the surgery.
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Aortic Stenosis In The Elderly
AS is a disease of the elderly and its impact is becoming more significant in the ageing world population. According to the 2001 United Kingdom census, there were 9790 people aged 80 and above in our local catchment area, which approximates to a local prevalence of 1.1% for severe symptomatic AS in this age group.
It is well recognized that the prognosis of untreated AS is poor. As there is no effective medical therapy and percutaneous valvotomy or replacement are currently not acceptable alternatives to surgery, current guidelines recommend that all elderly patients with severe symptomatic AS should be considered for AVR, regardless of age. These recommendations are based on the following observations: first, the operative risk of AVR in octogenarians and even nonagenarians are reasonable, ranging from 5.2% to 9.6% for isolated AVR. Secondly, surgical patients achieve improved post-operative quality of life scores, comparable to the general population., Furthermore, econometric analysis has also shown that AVR is cost-effective for patients up to the age of 90. In keeping with previous studies, only 40% of our cohort was considered to be eligible for AVR. Therefore, the excellent operative results reported by large-volume tertiary centers in elderly patients undergoing AVR for severe AS could be in part due to referral bias.,
Comparison With The Operation Year
To establish a comparative population-based reference survival curve, we generated a baseline Kaplan-Meier curve for an age-matched, gender-matched and year-matched patient population using the life tables of ONS. For each patient in our cohort, we used the annual mortality probabilities from the ONS life tables to run Monte Carlo simulations for that individual’s survival, starting from the year of operation and advancing in yearly increments. The patient-level events were then aggregated across the cohort to generate a final aggregate KM curve, representing the expected survival behaviour of the matched general population. For each patient, 1000 MC runs were performed to generate statistically sufficient events and produce a reliable baseline survival curve.
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Funding Support And Author Disclosures
This work was supported by grants from The Swedish Heart-Lung Foundation , The Swedish state under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors , and Västra Götaland Region , and Family Nils Winbergs Foundation. The supporting bodies had no influence on the analysis and interpretation of data, on the writing of the report, or on the decision to submit the paper for publication. Dr Omerovic has received an institutional research grant from AstraZeneca has received consultancy fees from Bayer and Novartis and has received speaker honorarium from Merck, Sharp & Dohme, all outside the present work. Dr Dellgren has received an institutional grant for the SweVAD study from Abbott and has received an institutional grant for the ScanCLAD study from Astellas. Dr Dellgren has received speaker’s fees from XVIVO, all outside the present work. Dr Milojevic has received speakers fees from LivaNova outside the present work. Dr Jeppsson has received fees for consultancy or lectures from Werfen, Boehringer Ingelheim, Portola, Baxter, and LFB Biomedicaments, all unrelated to the present work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.