Heart Valve Repair vs. Replacement

Heart Valve Repair

Heart valve repair is a procedure to repair native valve function instead of replacing it with a mechanical or biological replacement device. The procedure is most frequently used to treat heart valves that do not close properly and leak, a condition call valve insufficiency. Valve repair may be more durable than biological valve replacement and avoids the complications associated with anticoagulation medications required with mechanical valve replacement.[1] Based upon the demonstrated superior patient benefits achieved with the procedure, valve repair has become the gold standard treatment for mitral valve insufficiency, comprising more than 70% of all isolated mitral valve procedures performed.[2]

Decades of experience with mitral valve disease have proven that the foundation of successful valve repair is stabilization of the valve annulus, a procedure called annuloplasty.[1] Annuloplasty is achieved by the surgical implantation of an annuloplasty ring which restore normal annular dimensions and prevents dilatation of the annulus with time. By combining annuloplasty with surgical techniques to repair damage to the valve leaflets and other valve structures, surgeons are able to routinely restore valve function and competence without removal of the patient’s native valve tissues.

Aortic Valve Repair

Aortic valve repair is potentially an attractive treatment option for patients with aortic valve insufficiency. Aortic insufficiency is the reverse flow of blood through the aortic valve back into the left ventricle resulting from inadequate closure of the aortic valve. Nearly all patients with aortic insufficiency have a dilated aortic valve root and many have damaged valve leaflets. Together, these geometric changes to the aortic valve anatomy contribute to valve dysfunction. Aortic insufficiency affects 0.5% of adults, or nearly 2.5 million people in the U.S. and Europe.[3]

Challenges of aortic valve repair:

  • Complex, three-dimensional anatomy of the aortic valve
  • Anatomical distortion from annular dilatation and leaflet degeneration
  • Complex trileaflet valve anatomy

Pioneers in aortic valve repair have demonstrated excellent long-term clinical outcomes, rivaling the results achieved with mitral and tricuspid valve repair, using their own unique surgical techniques.[4] Despite the promising results obtained with current aortic valve repair approaches, utilization of aortic valve repair lags significantly behind mitral and tricuspid valve repair. Approximately 95% of patients who undergo surgery for aortic valve disease receive mechanical or biologic valve replacement.[5] A fundamental factor contributing to minimal progression of aortic valve repair has been the lack of medical device technologies to simplify and standardize the surgical procedure (biotech). In particular, rigid internal annuloplasty devices have not been available to serve as the foundation of repeatable aortic valve repair.

Potential benefits of aortic valve repair:

  • Lower operative mortality
  • Lower risk of valve related complications
  • No need for long-term anti-coagulation therapy
  • Improved long-term ventricular function
  • Improved long-term survival

The HAART Aortic Valve Repair Technologies include annuloplasty devices, instrumentation, and repeatable implantation procedures developed specifically to simplify and standardize aortic valve repair.

  1. Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thoracic Cardiovasc Surg 2014;148:e1-132.
  2. Gamimie JS, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thoracic Surg 2009;87:1431-9.
  3. Nkomo VT, et al. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005-11.
  4. Saczkowski R, et al. Systematic review of aortic valve preservation and repair. Ann Cardiothorac Surg 2013;2(1):3-9.
  5. Funkat A, et al. Cardiac Surgery in Germany during 2013: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014;62:380–392.