A normal aortic valve has three leaflets, or flaps, that open to pump blood out of the heart when it contracts and close tightly when it relaxes. However, nearly two percent of the population have a bicuspid aortic valve with only two leaflets. A bicuspid valve is often asymptomatic early in life and only found by a physician who hears a murmur when listening to the heart or during a test to diagnose another condition.

Although many people live a normal life without the valve causing any problems, nearly 50% will require aortic valve surgery within 25 years of diagnosis, according to the Journal of the American Heart Association. The most common reason for surgery is the formation of an aortic root aneurysm, a stretching out and enlargement where the aorta meets the aortic valve.  Once an aneurysm forms, it must be monitored and managed closely because it tends to get larger over time.

Once the aortic root aneurysm reaches 5 to 5.5 centimeters in diameter, surgeons require surgical repair or replacement since there is a risk of the area rupturing, which is a life-threatening situation.

We received a great question about this from Sandra, who is experiencing this exact problem. She asks, “I have a bicuspid aortic valve with aortic regurgitation and aneurysm. I’ve been told I need a replacement, but I’m learning about valve-sparing techniques on your website. Is valve-sparing the same as an aortic valve repair, and what are the outcomes of valve-sparing procedures?”

Dr. Joanna Chikwe

To answer Sandra’s question, I was thrilled to connect with Dr. Joanna Chikwe in her office at Cedars-Sinai Medical Center in Los Angeles, California. Dr. Chikwe is the Founding Chair of Cardiac Surgery at Cedars-Sinai and a great resource for detailed answers to patient questions.  During her extraordinary career, Dr. Chikwe has performed thousands of heart valve operations and has successfully treated many patients in our community.

Key Learnings About Valve-Sparing Aortic Root Replacement

Here are important insights from Dr. Chikwe:

• Many times, the valve leaflets don’t need to be repaired. “That is a great question and one of my favorite operations,” said Dr. Chikwe. “Generally, you don’t have to repair the valve leaflets. Oftentimes, patients have no aortic leak, and we’re replacing or repairing the aneurysm around the valve.
• What are the outcomes of the valve-sparing aortic root replacement procedures? “Phenomenal safety records and great durability,” Dr. Chikwe told us. “Patients should expect to live a decade, two decades without any need for further surgery on the aorta.”
• Is there sometimes a difference in how the valve looks on the echocardiogram versus during surgery that needs to be addressed? “Very rarely,” Dr. Chikwe said. “Usually you’ve got a pretty good idea from the echo if there’s calcium or reduced leaflet mobility that will make it difficult to preserve the valve.” Chikwe said the goal is always to repair the valve, especially if it’s a younger patient with normal leaflets and an aneurysm. “It’s great if we can keep that valve, and that’s a valve-sparing root replacement,” she said.
• Patients often ask about how the aneurysm is fixed and what is done to ensure blood flows with no risk of a dissection or tear. Chikwe said, “The goal is to replace as much of the abnormal aorta as we can with a tube made of Dacron. It’s a polyester that isn’t going to stretch. The more aorta we can replace at one time, the less chance of developing an aneurysm in the future.”

Thanks Dr. Chikwe and Cedars-Sinai Medical Center!

Many thanks to Dr. Joanna Chikwe for everything you and your team at Cedars-Sinai do for HeartValveSurgery.com patients like Sandy and patients all over the world!

Related links:

• Ask Dr. Chikwe: Stopping The Heart Before Cardiac Surgery
• See 50+ Patient Reviews for Dr. Chikwe

Keep on tickin,
Adam