Cedars-Sinai has a long history of innovation in heart valve surgery. In 1978 Cedars-Sinai became the second program in the United States to implant the St. Jude valve. We continue that innovative tradition with a wider spectrum of valve replacement procedures.
The Decision to Repair or to Replace
The decision to repair versus replace a valve is based on complex factors.
At Cedars-Sinai a repaired valve is expected to have a life of at least 10 years (comparable to the minimum expectation for a bioprosthesis). If the repaired valve is not projected to last at least that long, the valve is replaced rather than repaired. Optimally a repaired valve should last a lifetime.
The decision is based on factors unique to each patient. These include the anatomy of the aortic valve and nature of the tissue. When a normal trileaflet aortic valve is present, there is greater potential for repair. Particularly during surgery for ascending aortic dissection involving a normal aortic valve, lifetime durable repairs are often possible.
Careful scrutiny is required for bicuspid aortic valves. In young patients where the bicuspid valve functions well with little calcification, or where there is a problem with only one leaflet, a durable repair may be possible. However, about 75% of bicuspid aortic valves cannot be repaired with the expectation of lasting for an acceptable period of time. In these cases, replacement is preferable.
Replacing Heart Valves
When the doctor determines that a patient's heart valve cannot be repaired, it must be replaced. Surgeons at Cedars-Sinai have extensive experience with all types of valve replacement surgery, including aortic valve replacement, mitral valve replacement and pulmonic (lung) valve replacement.
Several different kinds of artificial valves are used for replacement surgery, including:
Preparing for and Recovering from Valve Surgery
Before surgery, patients need to complete all dental work. Dental infections can allow bacteria to enter the bloodstream and infect the new heart valve - a condition that is very hard to treat.
After surgery, patients need to:
- Take a blood thinner
- Take antibiotics about an hour before going to the dentist
- Report any skin, foot or hand infections to the doctor so that they can be treated aggressively to prevent spreading the infection to the blood or the heart valve
- Report fevers that are high, last a long time or keep coming back because fevers may indicate an infection that could spread to the blood or new heart valve