“A New Trend To Aortic Vave Repair Surgery?” with Dr. Bavaria
By Adam Pick on April 19, 2013
In the past, I’ve filled this blog with hundreds of stories about mitral valve repair procedures. However, over the past 12 months, I have started to hear and report about aortic valve repair surgery — from patients and physicians.
To learn more about this new trend to aortic valve repair surgery, I met with Dr. Joseph Bavaria. So you know, Doctor Bavaria is the Vice Chief, Division of Cardiovascular Surgery and the Director of the Thoracic Aortic Surgery Program at Penn Medicine. In addition, Dr. Bavaria has performed successful surgery on many members of our community including Rebecca Roberts, Hubert Karreman and Craig Fisher.
I hope this video helped you learn more about the rising use of aortic valve repair operations for patients experiencing aortic regurgitation (leaky valves). Many thanks to Dr. Joseph Bavaria for sharing his clinical expertise and research with our community.
Keep on tickin!
P.S. A written transcript of this video is provided below:
Dr. Joseph E. Bavaria: Hi. I am the Vice Chair of the Department of Cardiac Surgery at University of Pennsylvania. I practice in Philadelphia, Pennsylvania. I am the director of the Thoracic Aortic Surgery program. I have been in practice as an attending cardiac surgeon for approximately 20 years. I have done about 6,000 open heart operations of which 4,000 are cardiac valve related.
Adam Pick: Can you tell us what attracted you to the field of cardiac surgery?
Doctor Bavaria: My next door neighbor actually was a vascular surgeon and that’s what got me into the surgical field and maybe the vascular surgical field very early on my career. Fundamentally, I was a chemical engineer and I went to medical school after chemical engineering. One of my early mentors was a cardiac surgeon. Based on the clinical aspects of cardiac surgery and the biophysics aspects of cardiac surgery — that is what got me hooked right away.
Adam Pick: Do you specialize in a particular type of valve surgery?
Joseph Bavaria, MD: Yes, most of the valve surgeries that I do are aortic valve related. Sometimes that is at the aortic root level which is more of a complex aortic valve operation. I do a lot of those — maybe 200 to 225 a year.
Adam Pick: In our patient community, we hear a lot about mitral valve repair, however we almost never hear about aortic valve repair. Why is that?
Dr. Joseph E. Bavaria: Well, aortic valve repair is simply not mature. The actual fundamentals of the conceptual background to understanding how to repair an aortic valve was not really developed until recently. The big difference between aortic valve repair and a mitral valve repair conceptually is that aortic valve surgery is in three dimensions and not two dimensions. The aortic valve is three dimensional valve — as opposed to mitral valve which is a two dimensional valve. We just did not understand the valve quite as much but now we are starting to understand it a lot. We are in the third dimension and we are able to repair these valves on the X, Y and Z plane. We are at the level now for those of us who do a lot of these, that we can repair almost any valve that is fundamentally leaky — in other words an insufficient aortic valve. If it does not have a lot of calcification on it, we can almost repair every one of those valves, as long as the valve leaflets are somewhat intact.
Adam Pick: What type of patients are candidates for aortic valve repair?
Joseph E. Bavaria, MD: Well, the first criteria for candidacy for aortic valve repair is to have a valve that is fundamentally leaky or insufficient, and has only a minimum amount of calcium or no calcification. If it is too calcified, we cannot really repair the valve. The second thing which we can only tell once we get inside is, “Are the leaflets intact enough to actually take a repair stitch?”. But, if you have that, we can repair a lot of valves. Now, we can repair three cusp valves and we can repair bicuspid valves. We can repair both. Both type of valves as long as both criteria are satisfied. Again, not too much calcification, pure aortic valve insufficiency. You got those, we are in good shape.
Adam Pick: Dr. Bavaria, what are the surgical outcomes for an aortic valve repair procedure?
Joseph Bavaria, M.D.: The results are excellent. They range from anywhere between 90 to 95% freedom from re-operation at ten years. In our series we have no reoperations yet. And, more importantly, with the more robust and kind of advanced techniques, we are getting a situation where we have 95% freedom from significant aortic valve insufficiency. So it is a very, very good operation for the patients who qualify.
Adam Pick: What is the number one piece of advice you would offer a patient who is considering aortic valve repair?
Dr. Joseph Bavaria: Well, the most important thing about someone who is effectively considering aortic valve repair is to go to surgeon who has the experience, the technical knowledge, and the conceptual depth to be able to do the procedure itself that requires a certain amount of experience, the number of cases that they have done — and maybe even a publishing record of some sort (so you can tell is this guy is really doing the operation, or really doing it well).