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BOSTON – On September 4 at 4:30 ET, surgeons at Brigham and Women's Hospital (BWH) in Boston replaced a patient's aortic valve during a live Internet broadcast. The webcast, which is the third in a series, is intended to educate medical students, cardiac surgeons, and the general public about the latest minimally invasive techniques now available for such a procedure.
Minimally invasive aortic valve replacement is not as widely performed as the more traditional form of surgery, which requires the patient to undergo a complete sternotomy in order to access the heart. However, the less-invasive form of the surgery is gaining popularity among cardiothoracic surgeons as technology improves and the benefits to the patients increase.
The aortic valve, located on the left side of the heart, is the opening through which blood is ejected to the rest of the body. When the valve does not work properly – either because of a birth defect or from wear associated with aging – it becomes too narrow or fails to close completely. Either condition usually causes extraordinary stress on the heart, and can cause fluid retention and eventually severe heart failure.
"While the success rate on this type of surgery is very high, the recovery process, traditionally, can be a painful experience for the patient," said Lawrence Cohn, MD, of BWH. "By performing the less-invasive version of this surgery, the patient may enjoy a faster and less uncomfortable recovery."
Cohn said that in addition to swifter recovery times and less post-operative pain, patients also require shorter respiratory support time and experience less blood loss. There is also a decreased risk of infection associated with the minimally invasive approach, Cohn said.
The most common congenital defect associated with the aortic valve is defined by the patient having only two, not three, leaflets, the flaps of tissue that come together to close the valve off. Patients who have this type of abnormality may be healthy for many years before the valve begins to malfunction, requiring surgery.
Another common problem occurs when calcium deposits build-up on a worn-out valve. This build-up can restrict the valve's movement, leaving the valve either unable to open or to close properly.
People experiencing problems with their aortic valve may experience shortness of breath, dizziness, chest pain, loss of consciousness, or a combination of these symptoms.
Aortic valves generally cannot be repaired, especially if calcified, and are almost always replaced, either with an artificial valve or a biological valve. Many doctors prefer using artificial valves for their durability, but most use biological valves because of no need for warfarin anticoagulation.
"After this surgery, patients usually can expect to return to healthy, and more active lifestyles," said Cohn. "Now that the procedure can be done with minimally invasive techniques, their quality of life immediately after surgery also improves significantly."
BWH is a 716-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. Internationally recognized as a leading academic health care institution, BWH is committed to excellence in patient care, medical research, and the training and education of health care professionals. The hospital's preeminence in all aspects of clinical care is coupled with its strength in medical research. A leading recipient of research grants from the National Institutes of Health, BWH conducts internationally acclaimed clinical, basic and epidemiological studies.