Cardiosurgery: Aortic valve stenosis — Aortic valve replacement. Treatment
Aortic valve stenosis (AVS) is one of the most common heart diseases characterized by a decrease in diameter of the aortic orifice, resulting in increased resistance to the blood flow from the left ventricle into the aorta. The AVS prevalence rate is about 25% of all heart defects, but it is usually accompanied by the other valve defects.
Conservative Treatment of Aortic Stenosis
Upon asymptomatic progression, the special treatment is usually not required. The patient is recommended to pass regular check-ups by a cardiologist and adjust his/her lifestyle. Upon moderate AVS decompensation, the drugs supporting the heart work and metabolism are prescribed:
- cardiac glycosides;
- antithrombotic agents;
- metabolic drugs;
Surgical Correction of Aortic Stenosis
The indications for AVS surgical treatment are determined individually, taking into account the intensity of symptoms and stenosis progression. In the preoperative period, the patient is prescribed a course of conservative therapy for prevention of operative and post-operative complications.
There are several methods of surgical correction of the aortic stenosis. The best option is chosen depending on severity of the clinical picture and preservation of the valve structures.
- Balloon dilatation is performed via a minimally invasive access through the femoral artery. A special probe is advanced through the vessels to the valve, which is expanded due to baloon inflation. The surgeon’s actions are controlled by X-ray methods and echocardiography.
- Valve plastics is indicated in the absence of gross structural abnormalities in the valve. The surgery requires an open access and use of cardiopulmonary bypass.
- Aortic valve replacement is the most common surgery for aortic stenosis. The surgery involves removal of the valve components and prosthesis implantation. Traditional prosthetics involves sternotomy and cardiopulmonary bypass connection.
- Transcatheter aortic valve replacement is a new technique, which allows implanting the prosthesis with a minimal trauma. In European clinics, the combined prostheses made of materials of biological and synthetic origin are used. A special implanting system has a self-expanding structure, due to which the prosthesis is firmly fixed in the right place.
Subject to adequate preparation and selection of the optimal surgical technique, the long-term positive results are observed in 80-85% of the operated patients.Hide
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