Dr Kaushalendra Rathore MCh FRACS
Cardiothoracic Surgeon
JJ group of Cardiothoracic Surgery
Valve surgery

Aortic, Mitra and Tricuspid valve surgery are commonest operative procedures in cardiothoracic surgery speciality. Etiopathology and presentation varies among different patients and demography.

• Aortic valve: AV can haver stenosis, regurgitation or both and reasons can vary from degenerative disease, rheumatic valve, infection, connective tissue disorder or congenital diseases. Aorta can be involved as well in these pathologies (figure 1).

• AV: These poorly functioning valves can be replaced with tissue valve or mechanical prosthesis (depending upon patient related factors). Valve repair can also be tried but results are not well established, and long-term outcomes are variable.

• Mitral valve: Again, these valves can also present with stenosis or regurgitation pathologies. Stenotic valves are managed with per-cutaneous ballooning or surgical replacement, while regurgitant lesions should be repaired first. Failure of repair is a known fact and should be discussed with the patient and if surgeon feels long-term re-intervention rate can be high then replacing the valve can be the best option. Sometimes heavy calcification makes repair difficult and better is to replace the valve (figure 2).

• Infection of the valves can affect both mitral and aortic valve simultaneously (figure 3).

• Do these procedures have risk? These surgeries have risk of low cardiac output, stroke, infection, pacemaker insertion, failure of repair and other systemic organ failures

• Does these surgeries can be done with smaller incisions? These valve surgeries can be done with minimally invasive approach in the selected cases but even them surgeon has to use Cardio-pulmonary Bypass (CPB) machine to support the heart and lungs. So, yes if you look at skin cut size, but in wholistic manner need of CPB machine reduces the significance of minimalistic approach.