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Liverpool Heart and Chest Hospital, Thomas Drive, L14 3PE
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Aortic Valve Repair and Ross Programme - Natural Valve Substitutes

Are you a young or middle aged adult who needs intervention on their aortic valve?

Problems related to the function of the aortic valve may arise from irregularities involving the leaflet tissue, the aortic root or a combination of both.  These problems can result in either valve narrowing (stenosis) or a valve leak (regurgitation) necessitating surgery to correct this.

The ethos in our team is to preserve your aortic valve leaflets wherever possible, typically if your valve is leaking (aortic regurgitation). If this cannot be achieved due to the fact your valve is thickened (aortic stenosis), we consider using the pulmonary valve (Ross Procedure) as the next best option in those patients less than around 60 years of age. If you are diagnosed with a swelling of your aorta around the aortic valve (aneurysm) this does not preclude repairing the leaflets but will require us to replace the aneurysm at the same time.

If you feel you may be a candidate, please discuss a referral to the Aortic Team with your GP or referring cardiologist. Any of the Aortic Team will be happy to discuss these options in more detail when you are seen in Aortic Clinic. You might expect to meet one of us depending on the appointment.

 

Options:

1) Isolated leaflet repairs

Aortic leaflet repair is not as well established as mitral valve repair, however certain leaflet pathologies with regurgitant valves may be amenable to repair. On occasions leaflet repair may require a stabilising ring to the aortic annulus and sometimes replacement of the ascending aorta to stabilise the sinotubular junction. Eligibility of patients for such procedures involves complex joint decision making with patients.

 

2) Valve reimplantation (David) or valve remodelling (Yacoub), with or without leaflet repair

These procedures fall under valve sparing root replacement in which the aortic root needs replacement with an artificial graft and your own valve reattached within that.

In patients with regurgitant aortic valves and aortic root aneurysms, it maybe that the pathologies can be repaired rather than replaced with a traditional Bentall-type root replacement (See Surgery). This provides well documented good long term outcomes for patients.

 

3) Ross Procedure (Adult)

Some young to middle aged patients (<60) with aortic stenosis may be eligible for a Ross Procedure. This procedure involves moving the pulmonary valve into the aortic position and provides a number of possible benefits including:

  1. “Living valve”
  2. Excellent haemodynamics
  3. Excellent survival
  4. Low infection risk
  5. Low clotting risk
  6. And no need for warfarin

Following all the above procedures you will be followed up for life by us to ensure we give you the best prospects of valve durability and survival.

Please see links below to Patient Education Aides