Treatment of Aortic Valve Insufficiency (avi) of Aortic Valve Repair

Aortic valve insufficiency (AVI) is the most common defect associated with the congenital or acquired heart valve damage. It is often combined with aortic stenosis. The risk of developing pathology increases with age. Most patients with aortic valve disease are older people. Nonetheless, the prevalence of its insufficiency reaches 10% in people after the age of 45 years.

The problem can be solved by aortic valve repair, although aortic valve replacement is more common. Many patients with heart valve disease go to Turkish hospitals for treatment. This country has a high level of medicine, and the cost of treatment in Turkey is lower than in the USA, developed countries of Europe and Asia.

Who needs aortic valve surgery?

The indications for surgical aortic valve repair or aortic valve replacement in patients with its insufficiency are as follows:

• Severe aortic regurgitation in patients with symptoms of the disease, regardless of whether the systolic function of the left ventricle is preserved
• Reduced ejection fraction of the left ventricle at rest up to 50%, including in patients with no symptoms
• Increased cavity of the left ventricle (dilatation), including in patients with preserved contractile ability
• Aortic valve insufficiency or aortic stenosis in patients who require additional surgical interventions on the heart (in this case, aortic valve replacement can be performed simultaneously with coronary artery bypass grafting or surgery on another heart valve)

The aortic valve is implanted during an open or endovascular surgical procedure. In recent years, a transcatheter aortic valve has been increasingly used. In this case an artificial valve is inserted through a small incision into the groin, through the blood vessels. The repair of the patient’s own aortic valve is less common.

Aortic valve repair

Sometimes patients with damaged aortic valve undergo its repair. Such a surgical procedure can be performed in case of not severe aortic valve insufficiency. To perform successful surgery, the aortic valve must correspond to the following requirements:

• Preserved structure
• Movable leaflets
• Absence of severe calcification (deposits of solid calcium salts that interfere with the functioning of the heart valve)

Many patients with heart valve insufficiency are not candidates for such an operation. They undergo aortic valve replacement. In addition, the repair is less common due to its temporary result. The valve replacement will still be required but a little bit later – in 5-10 years.

Nonetheless, the aortic valve repair compared to aortic valve replacement has advantages as well:

• Lower price of treatment
• Preservation of the patient’s own heart valve
• No need for long-term anticoagulants intake (these drugs are a limitation for many other surgical procedures, as they increase the risk of bleeding)
• Lower risk of complications (the operation will not cause thromboembolism, bleeding, endocarditis, which can sometimes occur after aortic valve replacement)

Surgical valve replacement

The patients with valvular heart disease usually require aortic valve replacement, but not repair. The valve replacement provides a more stable result. It solves all problems at once: aortic valve replacement eliminates not only its insufficiency, but also stenosis.

Two types of prostheses can be used to replace the heart valve: 

• Mechanical – they are characterized by high wear resistance and consist of stainless steel, ceramic or pyrolytic carbon; their shape may be monoleaflet, bileaflet and caged-ball
• Biological – they have better compatibility and are made from animal (porcine or bovine) or allogeneic tissues

In recent years, the replacement of the aortic valve with a biological prosthesis has been increasingly performed. This is due to the fact that the new valves are almost equal to the mechanical ones in their durability. In most patients with valve replacement, the repeated operation will not be required even in decades.

Aortic valve replacement surgery is generally safe. Among the patients with concomitant pathology and at the age over 60 years, the mortality rate can reach 4-6%. However, in the age category under 60 years, the mortality rate in modern hospitals does not exceed 1-3%. The risks are higher if an additional intervention is performed at the same time as the aortic valve is replaced, for example, coronary artery bypass grafting.

Transcatheter aortic valve implantation (TAVI)

In Turkish hospitals, the doctors implant transcatheter aortic valves. These are minimally invasive procedures. The aortic valve replacement is performed through a small incision in the groin. A doctor inserts the transcatheter aortic valve through blood vessels. The heart valve replacement is performed using a less traumatic method, and therefore it is suitable even for patients with high operational risks.

The transcatheter aortic valve has only recently become one of the main treatments for aortic insufficiency. For a long time, the priority operation was the surgical aortic valve replacement. Only patients with the high surgical risk were candidates for the transcatheter aortic valve replacement.

As new research results were obtained, the indications for the procedure were expanded. It turned out that the transcatheter aortic valve replacement gives the same results as the conventional valve replacement. At the same time, its implantation is minimally traumatic and safe for the patient. The transcatheter aortic valve began to be implanted even in patients with moderate surgical risks. Today, the method is used even in the patients with low risks.

There can be used different approaches for minimally invasive aortic valve replacement: 

• Transfemoral – valve replacement through the femoral artery (is used most often)
• Transapical – aortic valve replacement through the left ventricular apex
• Transclavicular – valve replacement through the axillary or subclavian artery
• Transaortic – aortic valve replacement through the ascending aorta (a doctor performs a small incision on the chest wall)

If the heart valve is replaced through the femoral artery, then the procedure does not even require general anesthesia – it can be performed under local anesthesia. This allows the procedure even for the patients with contraindications to anesthesia. However, in some cases, the heart valve cannot be replaced through the femoral artery. Patients with atherosclerosis or pathological tortuosity of the arteries require other surgical accesses.

To date, there are more than 10 types of transcatheter aortic valves. Type of the valve is selected individually for each patient. The main types are balloon expandable and self-expanding transcatheter aortic valves. They may be inserted percutaneously and reduce risks of the intervention significantly. Percutaneous aortic valves are not as durable as the mechanical ones, their service life is similar to biological prostheses.

In some Turkish hospitals, minimally invasive aortic valve replacement is performed using the "valve-in-valve" technique. This means that, in fact, it is not valve replacement that takes place, but the heart valve implantation without the need to remove the aortic valve itself.

Why is it better in Turkey?

Every year, hundreds of thousands of medical tourists from all over the world undergo treatment in Turkey. The demanded services include cardiac surgery.

Many patients with heart valve disease come to Turkish hospitals. Here some of the main benefits of treating aortic valve insufficiency in Turkey:

• Experienced cardiac surgeons who perform dozens of operations to reconstruct or replace heart valves every year
• High efficiency of the surgical treatment of patients with heart valve diseases
• Use of minimally invasive methods of heart valve repair and heart valve replacement
• Possibility of transcatheter valve replacement
• Low risk of complications of aortic valve replacement
• Minimal health risks even in the patients with concomitant pathologies
• Low cost of treatment in Turkey
• Comfortable hospitals
• Quality care after AVI in Turkey, adequate pain relief, symptomatic treatment

Many patients with heart defects from developed countries are attracted not so much by the quality of medicine, but by the affordable cost of treatment in Turkey. Many of them could receive medical services of similar quality in their home country, but they come to Turkish hospitals to undergo valve replacement cheaper.

Where to seek medical help from?

To undergo treatment in Turkey, you can use the Booking Health service. Our portal presents the main clinics, medical programs, and prices.

Doctors treat aortic valve insufficiency in Turkey using different methods. The most common surgical procedure is aortic valve repair, but the aortic valve replacement can sometimes be performed as well. The cost of treatment in Turkey is attractive for medical tourists.

To choose and book AVI in Turkey at the best price, pleaseб use the services of Booking Health. We offer the following benefits:

• Selection of the best Turkish hospital for valve repair or AVI in Turkey
• Direct communication with a doctor who performs valve repair or valve replacement
• Reduced waiting time for treatment of aortic valve insufficiency in Turkey
• Appointment for treatment in Turkey on the most suitable dates
• Reduced cost of treatment in Turkey – prices for aortic valve repair or replacement will be reduced due to avoiding additional coefficients for foreign patients
• Information on the costs of AVI treatment in Turkey, price control and refund of unspent funds
• You will receive an insurance in the amount of up to 200 thousand euros, so the cost of treatment in Turkey will not increase even in the case of complications
• Preparation of a program for performing AVI in Turkey without the need to repeat previous diagnostic examinations
• Buying and forwarding medicines
• Communication with the hospital after completion of treatment of aortic valve insufficiency in Turkey
• Organization of additional diagnostics, treatment in Turkey or rehabilitation after surgical correction of aortic valve insufficiency

Booking Health specialists provide quality service. We will book a hotel and airline tickets for you, meet you at the airport and take to the hospital by car.