Aortic stenosis is the narrowing of the exit of the left ventricle of the heart, such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercising. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without causing obstruction is known as aortic sclerosis.
The aortic valve is a valve in the heart of humans and most other animals, located between the left ventricle and the aorta. It is one of the four valves of the heart and one of the two semilunar valves, the other being the pulmonary valve. The aortic valve normally has three cusps or leaflets, although in 1–2% of the population it is found to congenitally have two leaflets. The aortic valve is the last structure in the heart the blood travels through before stopping the flow through the systemic circulation.
Aortic valve replacement is a cardiac surgery procedure whereby a failing aortic valve is replaced with an artificial heart valve. The aortic valve may need to be replaced because of aortic regurgitation, or if the valve is narrowed by stenosis.
An artificial heart valve is a one-way valve implanted into a person's heart to replace a heart valve that is not functioning properly. Artificial heart valves can be separated into three broad classes: mechanical heart valves, bioprosthetic tissue valves and engineered tissue valves.
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the heart. After the left atrium fills with blood, the mitral valve allows blood to flow from the left atrium into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the left atrium or lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets, known as cusps.
Transcatheter aortic valve implantation (TAVI) is the implantation of the aortic valve of the heart through the blood vessels without actual removal of the native valve. The first TAVI was performed on 16 April 2002 by Alain Cribier, which became a new alternative in the management of high-risk patients with severe aortic stenosis. The implantated valve is delivered via one of several access methods: transfemoral, transapical, subclavian, direct aortic, and transcaval, among others.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patient's heart is replaced by either a mechanical or tissue (bioprosthetic) valve.
The Bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with re-implantation of the coronary arteries into the graft. This operation is used to treat combined disease of the aortic valve and ascending aorta, including lesions associated with Marfan syndrome. The Bentall procedure was first described in 1968 by Hugh Bentall and Antony De Bono. It is considered a standard for individuals who require aortic root replacement, and the vast majority of individuals who undergo the surgery receive mechanical valves.
The Ross procedure, also known as pulmonary autograft, is a heart valve replacement operation to treat severe aortic valve disease, such as in children and young adults with a bicuspid aortic valve. It involves removing the diseased aortic valve, situated at the exit of the left side of the heart, and replacing it with the person's own healthy pulmonary valve (autograft), removed from the exit of the heart's right side. To reconstruct the right sided exit, a pulmonary valve from a cadaver (homograft), or a stentless xenograft, is used to replace the removed pulmonary valve. Compared to a mechanical valve replacement, it avoids the requirement for thinning the blood, has favourable blood flow dynamics, allows growth of the valve with growth of the child and has less risk of endocarditis.
David H. Adams is an American cardiac surgeon and the Marie-Josée and Henry R. Kravis Professor and Chairman of the Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai Hospital in New York City. Dr. Adams is a recognized leader in the field of heart valve surgery and mitral valve reconstruction. As director of Mount Sinai Mitral Valve Repair Center, he has set national benchmarks with >99% degenerative mitral valve repair rates, while running one of the largest valve repair programs in the United States. Dr. Adams is the co-inventor of 2 mitral valve annuloplasty repair rings – the Carpentier-McCarthy-Adams IMR ETlogix Ring and the Carpentier-Edwards Physio II Annuloplasty Ring, and is a senior consultant with royalty agreements with Edwards Lifesciences. He is also the inventor of the Tri-Ad Adams Tricuspid Annuloplasty ring with a royalty agreement with Medtronic. He is a co-author with Professor Alain Carpentier of the benchmark textbook in mitral valve surgery Carpentier's Reconstructive Valve Surgery. He is also the National Co-Principal Investigator of the FDA pivotal trial of the Medtronic-CoreValve transcatheter aortic valve replacement device.
Marian Ion Ionescu was a Romanian-born British cardiac surgeon. His interest in heart surgery covered several aspects of this specialty. He was an inventor of surgical devices, mostly artificial heart valves, a scientist in the broad term and a medical educator. Ionescu died on 12 October 2023, at the age of 94.
Minimally invasive cardiac surgery, encompasses various aspects of cardiac surgical procedures that can be performed with minimally invasive approach either via mini-thoracotomy or mini-sternotomy. MICS CABG or the McGinn technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an anterolateral mini-thoracotomy.
The pericardial heart valve was invented by Marian Ionescu, a British surgeon working at the General Infirmary in Leeds, England. He created this artificial bioprosthetic heart valve as a three-cusp structure made of chemically treated bovine pericardium attached to a Dacron cloth-covered titanium frame.
Apicoaortic Conduit (AAC), also known as Aortic Valve Bypass (AVB), is a cardiothoracic surgical procedure that alleviates symptoms caused by blood flow obstruction from the left ventricle of the heart. Left ventricular outflow tract obstruction (LVOTO) is caused by narrowing of the aortic valve (aortic stenosis) and other valve disorders. AAC, or AVB, relieves the obstruction to blood flow by adding a bioprosthetic valve to the circulatory system to decrease the load on the aortic valve. When an apicoaortic conduit is implanted, blood continues to flow from the heart through the aortic valve. In addition, blood flow bypasses the native valve and exits the heart through the implanted valved conduit. The procedure is effective at relieving excessive pressure gradient across the natural valve. High pressure gradient across the aortic valve can be congenital or acquired. A reduction in pressure gradient results in relief of symptoms.
Donald Nixon Ross, FRCS was a South African-born British thoracic surgeon who was a pioneer of cardiac surgery and led the team that carried out the first heart transplantation in the United Kingdom in 1968. He developed the pulmonary autograft, known as the Ross procedure, for treatment of aortic valve disease.
Nina Starr Braunwald was an American thoracic surgeon and medical researcher who was among the first women to perform open-heart surgery. She was also the first woman to be certified by the American Board of Thoracic Surgery, and the first to be elected to the American Association for Thoracic Surgery. In 1960, at the age of 32, she led the operative team at the U.S. National Institutes of Health (NIH) that implanted the first successful artificial mitral human heart valve replacement, which she had designed and fabricated.
Decellularized homografts are donated human heart valves which have been modified via tissue engineering. Several techniques exist for decellularization with the majority based on detergent or enzymatic protocols which aim to eliminate all donor cells while preserving the mechanical properties of the remaining matrix.
Marjan Jahangiri FRCS, FRCS (CTh) is Professor of Cardiac Surgery at St. George's Hospital, University of London. She was the first woman to be appointed professor of cardiac surgery in the United Kingdom and Europe.
Tissue engineered heart valves (TEHV) offer a new and advancing proposed treatment of creating a living heart valve for people who are in need of either a full or partial heart valve replacement. Currently, there are over a quarter of a million prosthetic heart valves implanted annually, and the number of patients requiring replacement surgeries is only suspected to rise and even triple over the next fifty years. While current treatments offered such as mechanical valves or biological valves are not deleterious to one's health, they both have their own limitations in that mechanical valves necessitate the lifelong use of anticoagulants while biological valves are susceptible to structural degradation and reoperation. Thus, in situ (in its original position or place) tissue engineering of heart valves serves as a novel approach that explores the use creating a living heart valve composed of the host's own cells that is capable of growing, adapting, and interacting within the human body's biological system.
Warren Hancock was an American inventor and biomedical engineer, best known for his pioneering work in the development of heart valve technology. He founded Hancock Jaffe Laboratories, which played a crucial role in advancing prosthetic heart valves and other biomedical innovations.
