Robotic-assisted aortic valve repair is a type of surgery. It uses robotic tools to fix a damaged aortic valve.
The aortic valve is one of the heart’s 4 valves. These valves help blood flow through the heart’s 4 chambers and out to the body. Sometimes, the valve stops working well and needs to be replaced. Your healthcare provider will replace the valve with an artificial one. Blood can then leave the heart and flow out to the body normally.
Robotic-assisted aortic valve repair is a type of minimally-invasive surgery. Minimally invasive means that the surgery uses smaller incisions than a traditional surgery. You may have an easier and faster recovery.
Along with smaller cuts, your surgeon uses a robotic instrument to help fix the valve. The robot has special tools attached to it. Your surgeon puts these tools and a camera through the small cuts. During the surgery, your surgeon sits at a nearby computer and controls the robot’s movements. Your surgeon is able to look at the surgery with a highly enlarged image.
The robotic tools may help surgeons do the surgery more exactly than they could with standard tools. Surgeons do this surgery while you are asleep under general anesthesia.
You might need an aortic valve repair 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.Both aortic stenosis and aortic regurgitation can result from getting older. Other causes of aortic valve disease include:
- Congenital birth defects such as bicuspid aortic valve
- Bacterial infection of the heart valve
- Dissection of the aorta
- Aneurysm of the aorta
- Certain gene problems such as Marfan syndrome
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:
- Excess bleeding
- Blood clot, possibly leading to stroke or a heart attack
- Complications from anesthesia
- Breathing problems
- Irregular heart rhythms
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. Ask whether you need to stop taking any medicine before your surgery. Do not eat or drink anything after midnight 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
- Before the surgery starts, you’ll get general anesthesia. It will help you sleep deeply and painlessly through the operation.
- During the operation, the 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 will 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 put the robotic tools and a camera through these small incisions.
- While sitting at a nearby computer, your surgeon will do the operation using the robotic tools. The surgeon is always in control of these instruments.
- Your surgeon will look at continuous images from the robotic camera during this surgery.
- Your surgeon will remove your current valve and replace it with a new one.
- Once the surgery is done, 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.
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 as soon as you can tolerate them. You will likely need to stay in the hospital for about 3 days. Sometimes your stay may be longer.
Make sure someone drives you home from the hospital. You may also need some extra help at home for a little while.
A little draining of fluid from your incisions is normal. Tell your healthcare provider if you have severe draining, redness, or fever. Also let your healthcare provider know right away if you have severe symptoms like sudden shortness of breath. Your stitches will be 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 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. 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 medical and dental procedures. It helps prevent an infection of your replacement valve. Ask your healthcare provider whether this applies to you.
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
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Management of adults with bicuspid aortic valve disease. UpToDate
Sudheendra, Deepak, MD,Fetterman, Anne, RN, BSN