Aortic Valve: Surgery, Recovery, Life

*Aortic valve surgery is a common and crucial procedure for many patients facing heart disease. In this in-depth interview, Peter Zombori speaks with Professor Jürg Grünenfelder from Hirslanden Zurich, who offers expert insights into what aortic valve surgery entails, from modern minimally invasive techniques to recovery expectations and the critical topic of life expectancy.***Peter Zombori:** Welcome, everyone. Today's medical talk features Professor Grünenfelder from Hirslanden Zurich, and our topic is aortic valve surgery. Welcome, Professor, and thank you for being here. My first question concerns the surgical procedure itself. Could you explain what's involved in aortic valve surgery?**Prof. Jürg Grünenfelder:** Aortic valve surgery is indeed very common; we operate on many patients with aortic disease. We primarily distinguish between aortic valve stenosis, which is the most frequent condition involving a calcified aortic valve, and aortic valve insufficiency, where the valve is leaking. The majority of our patients present with aortic valve stenosis.When we operate on these patients, they typically undergo a valve replacement. At our institutions, we perform aortic valve replacement **minimally invasively**, meaning we do not split the chest bone. Instead, we make a small incision, about three to four centimeters, in the right chest to allow the new valve to be inserted. The remainder of the procedure is endoscopically assisted, performed with the help of a heart-lung machine. For standard aortic valve replacement, we use the heart-lung machine to stop the heart, and this is also installed minimally invasively through the groin by cannulating the vessels there.**Peter Zombori:** Just out of my own interest, how big is the aortic valve? Is it typically around a centimeter?**Prof. Jürg Grünenfelder:** That also depends on the individual patient, but we typically see measurements ranging from 20 millimeters to 30 millimeters in diameter within our patient population.**Watch the full video here:****Peter Zombori:** So, it's super small! How do you manage to perform the surgery? Do you go from the side with a camera and small instruments to get it out and put it in?**Prof. Jürg Grünenfelder:** Yes, it is endoscopically assisted. However, with this small incision from the right side, you can often have direct vision of the valve. It's a direct trajectory to the aortic valve, providing a perfect view. We then suture the new valve prosthesis in place. There are also newer valves that don't require sutures anymore, though the choice depends on the specific type of valve we wish to implant. We select the appropriate prosthesis from our inventory to ensure a perfect fit for the patient.**Peter Zombori:** Recovery time is always a significant concern in these discussions. How much downtime does a patient need to consider after aortic valve surgery?**Prof. Jürg Grünenfelder:** The recovery time is indeed patient-dependent. Patients with aortic valve stenosis are typically a little older, usually 60 to 70-plus years, so their recovery time is generally longer than for younger patients. However, with the small incision used in mini-thoracotomy, the pain is very minimal. For the first two to three days, they might feel more fatigued, but they recover very quickly. They are usually able to ambulate after two to three days and leave the hospital after about six days.Since we are in Switzerland, our healthcare system is very well-equipped with rehabilitation possibilities. We send all patients who wish to a cardiac rehabilitation facility after surgery. They typically go directly from the hospital after six days for an additional two to three weeks of rehabilitation.**Peter Zombori:** So, the total downtime is roughly three to four weeks. The other important question for patients undergoing aortic valve surgery is about life expectancy. Can you comment on this?**Prof. Jürg Grünenfelder:** Life expectancy, as always, depends on the individual patient. In this regard, we must also bear in mind that we implant different types of aortic valve prostheses: **mechanical** or **biological valves**. There is a difference in their performance and life expectancy.The life expectancy of a biological valve is not unlimited. We usually estimate it to be around 15 years, after which the valve tends to deteriorate, and the patient may need a second intervention. However, if they receive a **mechanical valve**, typically made of metal or carbon, it requires lifelong full anticoagulation. This, of course, has its downsides, such as an increased risk of bleeding in case of an accident or trauma. Despite this, the mechanical valve itself has a very long life expectancy. Patients with a mechanical valve, if they adhere to the anticoagulation rules, generally have pretty much the same life expectancy as the normal population. However, it is still an implanted valve, so I would consider the life expectancy to be slightly less than without a valve prosthesis. In general, though, patients live a normal life with no pain or limitation to their performance. They can do whatever they want. But, as I said, an implanted valve does have some inherent limitations.**Peter Zombori:** Thank you, Professor Grünenfelder. We aim to keep these interviews concise, so I truly appreciate you providing such insightful expertise. Thank you, and all the best.**Prof. Jürg Grünenfelder:** Thank you very much for having me.