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Robotic-Assisted Aortic Valve Repair

What is robotic-assisted aortic valve replacement?

Robotic-assisted aortic valve replacement is a type of minimally-invasive surgery. Minimally invasive means that the surgery uses smaller incisions than a traditional or open surgery. You may have a quicker recovery. The surgeon uses robotic tools to replacea damaged aortic valve.

The heart has 4 valves. These valves help blood flow through the heart and out to the body by promoting forward flow and preventing backflow. The aortic valve lies between the left ventricle (the left pumping chamber of the heart) and the aorta (the blood vessel that carries blood away from the heart to the rest of the body. Sometimes, the valve stops working well and needs to be replaced. Your surgeon will replace the valve with an artificial one. Blood can then leave the heart and flow out to the body normally.

Not everyone is a candidate for robotic-assited aortic valve replacement.Surgeons do this surgery while you are asleep under general anesthesia.

Why might I need robotic-assisted aortic valve replacement?

You might need an aortic valve replaced if your valve is not working as it should. That may happen for a number of reasons. In aortic stenosis, the valve is not able to open fully. So the heart must work harder to pump the blood across the narrowed valve. In aortic regurgitation, the valve is leaky. Some blood re-enters the pumping chamber of the heart instead of moving out to the rest of the body.

These health problems may lead to symptoms, such as shortness of breath, tiredness, swelling in your legs, and unpleasant awareness of your heartbeat. If these symptoms get worse, you may need surgery. In some cases, your healthcare provider may recommend surgery even if you don’t have major symptoms. Surgery works best when symptoms have not advanced too far.

Aortic valve disease can result from getting older. Other causes o include:

  • Congenital birth defects such as bicuspid aortic valve

  • Bacterial infection of the heart valve

  • Dissection of the aorta

  • Aneurysm of the aorta

  • Certain genetic problems such as Marfan syndrome

If you need an aortic valve replaced, talk with your healthcare provider about whether robotic-assisted aortic valve replacement might be right for you. It may lead to less pain and a shorter recovery. .

What are the risks for robotic-assisted aortic valve replacement ?

Any type of surgery has risks. Your risks will vary based on your health, your age, and other factors. Talk with your healthcare provider about your concerns.

Most people who have robotic-assisted aortic valve surgery will have a successful outcome. Possible risks include:

  • Infection

  • Excess bleeding

  • Blood clots, possibly leading to stroke or a heart attack

  • Complications from anesthesia

  • Breathing problems

  • Irregular heart rhythms, in some cases requiring a permanent pacemaker

How do I get ready for robotic-assisted aortic valve replacement?

As you plan for the surgery, you and your healthcare provider will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve. Biological valves are made mainly of pig, cow, or human heart tissue. Mechanical valves are man-made. The downside of biological valves is that they don’t last as long as mechanical valves. But people with mechanical valves need to take blood-thinning medicine for the rest of their life. Mechanical valves also raise the risk of infection for the new valve.

Talk with your healthcare provider about how to get ready for your surgery. If you smoke, try to stop smoking beforehand. It may lower your risk for complications. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines, vitamins, and herbal supplements. Talk with your healthcare provider about whether you need to stop taking any medicine before your surgery. Follow your healthcare provider's instructions about not eating or drinking anything for the specific amount of time before your surgery.

You may need some routine tests beforehand. These may include:

  • Chest x-ray, to check your lungs

  • Electrocardiogram (ECG), to check your heart rhythm

  • Basic blood tests, to check your general health

  • Echocardiogram, to look at your current valve

  • Cardiac catheterization, to look for blockages in the coronary arteries

What happens during robotic-assisted aortic valve replacement?

Check with your healthcare provider about the details of your surgery. In general, you can expect the following:

  • Before the surgery starts, you’ll get general anesthesia. It will help you sleep deeply and painlessly through the operation. Afterwards, you won't remember the surgery.

  • During the operation, the surgery staff will closely watch your vital signs. That includes your heart rate, blood pressure, breathing, and oxygen levels.

  • Before and after the surgery, you may get antibiotics to help prevent infection.

  • You may be attached to a heart-lung machine. This machine acts as your heart and lungs during the surgery.

  • Your surgeon will make some small incisions in the spaces between your ribs.

  • Your surgeon will insert several precision-guided robotic arms into these incisions. These arms hold and manipulate tiny instruments to do the required tasks. A tiny video camera will also be inserted to provide a magnified, three-dimensional image of the operating site.

  • Your surgeon will control the robotic arms and camera from a console located within the operating site.

  • Your surgeon will look at continuous images from the robotic camera during this surgery.

  • Your surgeon will removeyour current valveand replace it with a new one.

  • Once the valve is replaced, the robotic tools, camera, and heart-lung machine will be removed.

  • The small incisions on your chest will be closed. A bandage will then be applied.

What happens after a robotic-assisted aortic valve replacement?

After your robotic-assisted aortic valve replacement surgery, you will start your recovery in the intensive care unit or a recovery room. When you first wake up, you might feel confused. You will be hooked up to several machines to watch your vital signs more easily. You might also have a tube down your throat to help you breathe.

Most people who have aortic valve replacement notice that their symptoms are better right away after surgery. You should expect a little pain afterward. But it shouldn’t be severe. You can have pain medicine if you need it. You can have normal foods once the breathing tube is removed and as soon as you can tolerate them. You will likely need to stay in the hospital for a few days. Sometimes your stay may be longer.

It is important to make sure someone drives you home from the hospital. You may also need some extra help at home for a little while.

A small amount of fluid draining from your incisions is normal. Tell your healthcare provider if you have a lot of drainage, redness, or fever. Also let your healthcare provider know right away if you have severe symptoms like sudden shortness of breath. You may have your stitches removed at a later appointment. Your healthcare provider will carefully watch you to make sure your surgery was successful.

You should need less recovery time than you would have from a standard or open aortic valve replacement. But you still may tire easily for a while after your surgery. Get more active as soon as your healthcare provider says it is OK. Avoid lifting anything heavy for several weeks. Talk with your healthcare provider about what is safe for you to lift. Also follow all your healthcare provider’s instructions about medicine, exercise, diet, and wound care. It will help your recovery.

Make sure all your healthcare providers and dentists know about your health history. You may need to take antibiotics before some dental procedures. This helps prevent an infection of your replacement valve. Talk with your healthcare provider about whether this applies to you.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • How long it will take to get the results

  • When and how will you get the results

  • Who to call after the test or procedure if you have questions or problems or an emergency

  • How much will you have to pay for the test or procedure

Online Medical Reviewer: Lu Cunningham
Online Medical Reviewer: Mary Mancini MD
Date Last Reviewed: 11/1/2016
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