Aortic valve replacement

Why are we operating?

Cutting out a stone-stiff valve and sewing in a new one, with the coronary openings watching from millimetres away.

Indication: Severe symptomatic aortic stenosis or regurgitation; the symptomatic stenotic valve is a countdown, not a diagnosis.

The operation in 4 steps

1. 01Bypass and aortotomy

2. 02Excising the valve

3. 03Sizing and implanting

4. 04Closing and weaning

Danger zones

• Left main coronary artery

  Two territories hang from one vessel; its disease changes the whole operative plan.

• AV nodal artery

  Injury or occlusion at the crux trades a rhythm for an infarct.

• Coronary sinus

  Thin-walled and posterior, easily torn by retraction during mitral exposure.