A Comprehensive Guide to Aortic Valve Replacement (AVR) and Mitral Valve Repair (MVR)

Overview

Heart valve diseases, such as aortic valve stenosis or regurgitation, and mitral valve prolapse, can significantly compromise cardiac function and overall health. Among the surgical interventions available, Aortic Valve Replacement (AVR) and Mitral Valve Repair (MVR) are two prominent procedures aimed at restoring normal valve function and improving patient outcomes.

Aortic Valve Replacement (AVR)

AVR is a surgical procedure primarily indicated for severe aortic valve diseases, including stenosis (narrowing) or regurgitation (leakage). During AVR, the diseased aortic valve is replaced with a prosthetic valve to restore proper blood flow from the left ventricle to the aorta. The surgery is typically performed under general anesthesia, and various techniques, including traditional open-heart surgery and minimally invasive approaches, may be utilized depending on the patient’s condition and surgeon’s preference.

>>Indications for AVR

Aortic Valve Stenosis: A condition characterized by the narrowing of the aortic valve opening, resulting in obstruction of blood flow from the left ventricle to the aorta.

Aortic Valve Regurgitation: Occurs when the aortic valve does not close properly, causing blood to leak back into the left ventricle during ventricular relaxation.

>>Surgical Procedure

• Incision: The surgeon makes an incision in the chest to access the heart, typically through a median sternotomy (open-heart surgery) or smaller incisions in minimally invasive approaches.
• Cardiopulmonary Bypass: The patient’s blood is diverted through a heart-lung machine to provide oxygenation and circulation while the heart is temporarily stopped.
• Valve Replacement: The diseased aortic valve is excised, and a prosthetic valve is implanted in its place. Prosthetic valves may be mechanical or biological, each with its advantages and considerations.
• Closure and Recovery: After ensuring proper valve function and hemostasis, the incision is closed, and the patient is monitored closely during the postoperative recovery period.

Mitral Valve Repair (MVR)

MVR is a surgical technique aimed at correcting abnormalities of the mitral valve, which separates the left atrium and left ventricle of the heart. Unlike AVR, MVR focuses on preserving the patient’s native valve whenever possible, rather than replacing it with a prosthetic device.

>>Indications for MVR

• Mitral Valve Prolapse: A common condition where the flaps (leaflets) of the mitral valve bulge back into the left atrium during ventricular contraction.
• Mitral Valve Regurgitation: Results from incomplete closure of the mitral valve leaflets, leading to the backflow of blood from the left ventricle into the left atrium.

>>Surgical Procedure

• Valve Assessment: The surgeon evaluates the structural integrity of the mitral valve and determines the extent of repair required.
• Repair Techniques: Various techniques may be employed to repair the mitral valve, including leaflet resection, annuloplasty (reinforcement of the valve annulus), chordal reconstruction, and artificial chord implantation.
• Outcome Assessment: Intraoperative techniques, such as transesophageal echocardiography, are used to assess the effectiveness of the repair and ensure proper valve function before concluding the procedure.
• Recovery and Follow-up: Patients undergo postoperative monitoring to assess valve function, manage symptoms, and prevent complications.

Conclusion

Aortic Valve Replacement (AVR) and Mitral Valve Repair (MVR) are essential surgical interventions for treating severe valvular heart diseases. While AVR involves the replacement of the diseased aortic valve with a prosthetic device, MVR focuses on preserving and repairing the patient’s native mitral valve whenever feasible. These procedures have revolutionized the management of valvular heart diseases, significantly improving patient outcomes and quality of life.

However, the selection of the appropriate surgical technique depends on various factors, including the patient’s condition, valve pathology, and surgical expertise, highlighting the importance of a multidisciplinary approach in the management of these complex cardiac conditions.