Valvular Disease
Another significant development in the emerging trend toward less traumatic and less morbid valvular heart surgery has been the development of improved natural tissue valves, which are being used in a large number of centers. Offering advantages similar to those inherent in mitral valve repair surgery, these bioprostheses are allowing for decreased valve-related morbidity in patients requiring aortic valve surgery.
Initially, demand for a less morbid aortic valve procedure led to increased use of the Ross operation, i.e., pulmonary autotransplantion for aortic valve replacement. Although moderately successful, the Ross procedure still requires a double-valve procedure in a patient with single-valve pathology, and has a 30% chance of reoperation at 12-15 years. Thus, the newer generations of bioprostheses offer great promise, with minimal valve-related morbidity. Engineering breakthroughs such as stentless valves to diminish stress points, zero pressure fixation tissue processing, and chemical treatments to mitigate against calcification may yield even better results.
A final topic, which may be the most significant innovation in the surgical treatment of valvular heart disease, is the development of minimally invasive techniques for valve repair and replacement. This major technical breakthrough has enormous potential for a surgical option that simultaneously offers excellent results with less procedure-related morbidity and improved cosmesis. It is in patients' best interest that cardiac surgeons, cardiologists, primary care physicians and patients themselves keep up-to-date with the evolution of this exciting new development.
| Major technical and technological advances in the treatment of valvular heart disease have fueled global trends toward minimization of morbidity through more natural and less traumatic approaches to surgery. This article will present an overview of these trends and summarize results of some of the latest research in the areas of mitral valve reconstruction, new options in aortic valve bioprosthesis and minimally invasive techniques for valvular surgery. In recent years, mitral valve reconstructive surgery has gained popularity over valve replacement for patients with mitral insufficiency. The technique was introduced by Carpentier in the late 1970s, and adopted early by us at NYU Medical Center and by others. Long-term results have demonstrated significant benefits for patients undergoing valve repair when compared to patients having valve replacement. Since the need for long-term anticoagulation is avoided, these benefits have primarily meant increased freedom from late valve-related morbidity, such as thromboembolic and anticoagulant-related complications.(4,5,6) Spencer recently reviewed our experience with valve repair and the lessons learned in over 1,000 patients, as part of an invited lecture to the Southern Thoracic Surgical Association.(7) |
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Initially, demand for a less morbid aortic valve procedure led to increased use of the Ross operation, i.e., pulmonary autotransplantion for aortic valve replacement. Although moderately successful, the Ross procedure still requires a double-valve procedure in a patient with single-valve pathology, and has a 30% chance of reoperation at 12-15 years. Thus, the newer generations of bioprostheses offer great promise, with minimal valve-related morbidity. Engineering breakthroughs such as stentless valves to diminish stress points, zero pressure fixation tissue processing, and chemical treatments to mitigate against calcification may yield even better results.
A final topic, which may be the most significant innovation in the surgical treatment of valvular heart disease, is the development of minimally invasive techniques for valve repair and replacement. This major technical breakthrough has enormous potential for a surgical option that simultaneously offers excellent results with less procedure-related morbidity and improved cosmesis. It is in patients' best interest that cardiac surgeons, cardiologists, primary care physicians and patients themselves keep up-to-date with the evolution of this exciting new development.