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The University of Maryland Heart Center's state-of-the-art aortic valve program offers all minimally invasive approaches, all techniques of valve surgery and all valve replacement choices to provide each patient with the best possible treatment.
You, with your surgeon, will choose:
The choices will depend on your opinion, your health history, and your surgeon's opinion.
Below are images showing the four different incision options our surgeons use for aortic valve surgery. The top image shows all four incisions, while the lower images show each specific option. Click on any of the links below the incisions, or scroll down, to learn more.
Incision A is a minimally invasive option. It is 6-10 cm in length and the surgeon works between the ribs to get to the ascending aorta as it arises from the heart and hence the aortic valve. Advantages include a more cosmetic result, a less invasive approach with less tissue damage, less blood loss and potentially shorter time on the ventilator and shorter hospital stay, resulting in a faster recovery. It is a good option for elderly patients who are at or below their ideal body weight. It is not a good option for very muscular or heavy-set patients.
Incision B is a smaller version of the standard sternotomy (see incision C). It is 6-10 cm in length and through a smaller incision allows the surgeon to open the upper part of the sternum only, which gives free access to the ascending aorta as it arises from the heart and hence the aortic valve. Advantages of this incision are a more cosmetic result, faster healing, less blood loss and need for transfusion, and potentially shorter hospital stay. It is an option for almost anyone receiving isolated aortic valve replacement. Please note that coronary artery bypass grafting can not be accomplished with minimally invasive incision options A or B. Incision B is an excellent option for someone who has had previous coronary artery bypass grafting and has an open internal mammary artery graft.
Incision C is the standard sternotomy and it is 17-25 cm in length. It has been performed hundreds of thousands of times and has been the tried and true incision used by cardiac surgeons for the last 40 years. In general it is well tolerated and less painful than other incisions of the same size. Its advantage is that it gives the surgeon complete access to the entire heart and allows work to be done efficiently and procedures such as operations on coronary arteries and other valves in the heart to be performed easily.
Incision D is between the ribs on the patient’s left side. It is the incision used to perform aortic valve bypass. Aortic valve bypass involves placing a tube in the very tip of the heart connected to a valve and then connected to the patient’s aorta in their chest, thus bypassing the aortic valve. Its advantages are that it completely avoids operating on an ascending aorta, which may have severe disease. This incision has been used by thoracic surgeons for many years. It is well tolerated and allows a rapid recovery. Another advantage of this approach is that it can be done with little if any time on the heart-lung machine.
For more information or to schedule a consult, please call 410-328-5842.