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aortic valve surgery - historical note:

In 1947, Smithy and Parker, at the University of South Carolina in Charleston, first reported an experimental study of aortic valvulotomy. In the early 1950īs, Bailey and collegues, in Philadelphia, used methods in clinical attempts to relieve severe aortic stenosis. In 1951, Hufnagel, in Washington, developed a ball valve prosthesis for rapid insertion into the descending aorta. More effective approaches began with the advent of clinical cardio-pulmonary bypass in 1954 and 1955. At first, aortic valvotomy and decalcification were all that could be done. Then Bahnson et al and Hufnagel and Conrad developed a single-leaflet prosthesis that became commercially available. Nevertheless, the introduction of the ball valve prosthesis by Harken and by Starr in 1960 established aortic valve surgery on a firm basis.
aortic valve surgery - indication:
The classic triad of effort dyspnea, angina, and syncope is present in about one-third of patients with aortic stenosis, due to calcific, rheumatic or arteriosclerotic (degenerative) aortic valve stenosis. The main reasons for aortic incompetence are rheumatic, due to annulo-aorto ectasia, endocarditis, aortitis and others.
 

aortic valve surgery
 

step 1:

After induction of circulatory support by extracorporeal circulation, cooling of the patient and the heart, the aorta is x-clamped and the aortic valve exposed after the aorta was opened. The aortic valve is examined and excised for subsequent aortic valve replacement.

step 2:

Sizing of the aortic anulus is done by a valve sizer - to select the size of the aortic valve prosthesis.

step 3:

Valve sutures are placed into the aortic valve anulus and into the heart valve prosthesis - to tie the valve prosthesis secure into the valve anulus.

step 4:

picture on the left (<-):

The artificial heart valve is in place.

picture on the right (->):

The aorta is closed by a running suture, the heart de-aired and the operation finished.

 

aortic valve surgery - results
 

Annual aortic valve operations since 1984 (yellow bars). Currently, about 360 aortic valve operations are performed in our hospital annually. Included in this data are also all re-operations (patients who have undergone previous surgery).

The overall perioperative mortality for all 2.641 aortic valve operations since 1984 in our clinic is 1.9%

 
results: 10 year follow-up of 804 aortic valve patients
(Aortic valve replacement operation in our hospital - using a biological Carpentier-Edwards Pericardial Valve) 
 

10 year actuarial survival after aortic valve replacement. Isolated aortic valve replacement operation (green): 60.2%. All aortic valve operations (incl. other procedures like coronary bypass etc) (blue): 54.7% 10 year freedom from thromboembolism. Isolated aortic valve replacement operation (green): 91.1%. All aortic valve operations (incl. other procedures like coronary bypass etc) (blue): 86.5%

10 year freedom from structural failure. Isolated aortic valve replacement operation (green): 98.0%. All aortic valve operations (incl. other procedures like coronary bypass etc) (blue): 97.7% 10 year freedom from reoperation. Isolated aortic valve replacement operation (green): 97.7%. All aortic valve operations (incl. other procedures like coronary bypass etc) (blue): 97.4%