Aortic Valve Replacement Videos

I wish to show you the main steps in performing an aortic valve replacement for a patient with aortic stenosis. In the case presented below, the patient has chosen a bioprosthesis, specifically a bovine pericardial valve. The reason the patient chose this valve is that he didn't want to be on Coumadin.

Once the patient is on the heart-lung machine and the heart is stopped, the first move is to open the aorta as shown below.

The next step is to expose the aortic valve as shown here. Note the heavy calcium deposits on the valve. This restricts the valve from opening properly.

Here's another example of a very heavily calcified valve.  In this video, I'm also shown pointed out the orifice of the left main and right main coronary arteries.

 

In the video below I begin to excise the calcified aortic leaflets.  Once all three leaflets are removed, I will debride the remaining calcium from the aortic annulus and begin placing sutures.

 

Now that the valve is excised, I need to carefully remove every last bit of calcium from the aortic annulus.  This will allow for the safe placement of sutures and allow the new valve to sit nicely on the annulus.  It's important to account for every piece of calcium, for if any were to break lose it could embolize to the brain and cause a stroke.

 

The next step is to place the pledgeted sutures into the aortic annulus.  These sutures will be later placed through the bioprosthesis.

 

Below I've completed putting all of the sutures into the heart.  Now it's time to place the sutures through the bovine prosthetic valve.

 

Now it's time to lower the bioprosthesis into the aorta and secure it to the patient.

 

Below you can see that I'm tying in the sutures and securing the valve in place.

Here's a nice view of the bioprosthesis in place.

Below are two videos showing how I close the aorta after the valve has been implanted.


Here's the final product.  The aorta is closed and the heart has been restarted and is beating nicely.  I'm checking to make sure there is no bleeding from the suture lines.  Now we are ready to separate the patient from the heart-lung machine and conclude the operation.