Valvular heart disease can affect any of the four valves of the heart. Aortic valve disease is a condition in which the valve between the left ventricle and the main artery to your body (aorta) does not work properly. Aortic valve disease sometimes may be a condition present at birth (bicuspid aortic valve) or it may result from other causes. The most common valvular problem in old age is aortic valve disease.
Types of aortic valve disease include: Aortic stenosis & Aortic regurgitation. In Aortic stenosis condition, the aortic valve opening is narrowed. Aortic regurgitation. In this condition, the aortic valve does not close properly, causing blood to flow backward into the left ventricle. To treat valvular disease, cardiac surgeons offer different possibilities:
1-Repair the patient´s own valve.
2-Replace the valve.
A. Heterograft valve. B. Mechanical valve. C. Homograft valve. D. Autograft (Ross procedure) E. Sutureless valve F. TAVI.
The physician and patient will choose the type of valve, taking into account the patients’ overall condition and preference. Some of the patient factors considered are:
Age and life expectancy: the American College of Cardiology and American Medical Association guidelines indicate that mechanical valves are generally appropriate for the majority of patients who are 65 years old and younger, or patients already on blood thinners treatment.
Other diseases: lung, liver and kidney disease, diabetes, cancer and other chronic conditions can affect life expectancy and alter the age criterion.
Heart and vascular system condition: Coronary, carotid and peripheral artery diseases and heart rhythm disturbances can affect valve selection.
Patient lifestyle and preference.
Heterograft valves: Tissue valves are harvested from pig heart valves (porcine) or cow heart pericardium (bovine). These tissues are treated so that the body will not reject them. The lifetime of a tissue valve is typically 10 to 15 years, often less in younger patients. Over this time the valve will likely be degenerating to the point of requiring replacement. Because of this possibility, patient life expectancy is a major criterion in considering a tissue valve. The primary advantage of tissue valves is their lower requirement for anticoagulation therapy, which reduces the incidence of bleeding. For the majority of tissue valve patients, taking an aspirin a day is sufficient anticoagulation therapy.
Mechanical Valves: The most widely used mechanical valves are made from pyrolytic carbon, which has been used for over 30 years. Most are bileaflet designs, meaning that they employ two carbon “leaflets” to regulate flow to a single direction. The primary advantage of mechanical valves is that they will last a patient’s lifetime. Mechanical valves are preferred for patients with life expectancies beyond 10-15 years because they eliminate the mortality risk inherent in the replacement of a degenerate tissue valve. The best mechanical valves have excellent flow performance, including the smaller sized ones. The main drawback of mechanical valves has been their requirement for warfarin anticoagulation therapy (blood thinners), with its accompanying risk of bleeding. With properly managed anticoagulation therapy, rates are low for both bleeding and clotting. Mechanical valves can sometimes be audible when opening and closing. The sound level varies with the patient, but only a small number of patients find the sound disturbing.
Homograft Valves: In some cases a homograft – a human aortic valve—can be implanted. Homograft valves are donated by people and recovered after the person dies. The durability of homograft valves is comparable to porcine and bovine tissue valves. The principal indication for aortic valve replacement using a homograft aortic valve is for active aortic valve endocarditis (native or prosthetic) with or without perivalvular tissue destruction (abscess cavity, fistula…). Since the homograft tissue is pliable and adaptable, it can be used to repair defects in complex cases with root destruction.
Autograft (Ross Procedure): In the Ross procedure, the diseased aortic valve is removed and replaced with the patient’s own pulmonary valve (autograft). After the pulmonary valve is transferred to the aortic position, a donor pulmonary homograft (human cadaver) valve is sewn into the pulmonary position, and the coronary arteries are re-implanted. Longevity of the pulmonary autograft in the aortic position is superior to bioprostheses: The Ross procedure is particularly appropriate for children and young adults with diseased aortic valves. The pulmonary has the potential to grow as the child grows (which artificial valves cannot do), and it is well suited to the high pressures in the aorta. The procedure is also a good option for women who wish to become pregnant and for active patients who do not wish to take anticoagulants.
“Sutureless”aortic valves: The concept is a prosthetic valve comprising a bovine pericardium tissue valve attached to a self-expandable anchoring device, which has the dual role of supporting the valve and providing fixation to the implantation site. Sutureless biological valves were designed to simplify and significantly accelerate the surgical replacement of a diseased valve and first require complete excision of the calcified native valve. Shortening the time required for aortic valve replacement may help to reduce the morbidity and mortality, especially in patients who require complex multivalve or combined valve and coronary procedures. F.TAVI Transcatheter aortic valve procedures (TAVI) may eliminate the need for open heart surgery in select groups of patients. As of October 2012, in the USA there is an FDA-approved percutaneously implantable aortic valve system for high surgical risk and inoperable patients with symptomatic aortic stenosis with other catheter-based devices on trial use.
Aortic Valve Replacement cost
While Aortic Valve Replacement cost can be really amazing in developing countries such as Thailand (22.000 USD including surgery, hospital Stay, hotel & airfare), in Western Europe countries the costs can be 60% more affordable than of USA’s cost.
Contact us and we can calculate your costs that will include the same services offered in Thailand but in a Western European country where quality standards are at least at the same level as the USA’s.