Although not as prevalent as coronary artery disease, disorders of the respective heart valves - aortic, mitral, tricuspid, and pulmonary - appear to be increasing as cardiovascular physicians are recognizing the importance of early intervention in order to avoid irreversible heart damage. At UNC, we take an aggressive approach to early valve repair and replacement (if indicated) using the latest state-of-the-art techniques.
The aortic valve is prone to degenerate over time and presents with either progressive narrowing termed aortic stenosis or progressive enlargement with subsequent valve incompetence. At UNC, we address all aortic lesions individually and create a patient-oriented solution. Often, the valve may be repaired as with patients with bicuspid valves or those associated with aortic root aneurysms. More frequently, however, the valve needs to be replaced. Options for replacement include stented bioprosthetic and mechanical valves, stentless porcine valves, homografts, and the Ross procedure (use of the patient's pulmonary valve in the aortic valve position).
Mitral stenosis (narrowing) and mitral regurgitation (leaking of the valve), especially if left unchecked, can result in severe heart dysfunction. Early intervention is crucial in managing these patients. Recently, we have adoptive minimally-invasive approaches to patients requiring both aortic and mitral valve procedures.
Historically, valve replacement surgery required opening the patient's chest with a transternal incision. Over the last 5 years, new techniques and surgical instrumentation have permitted valve surgery without a median sternotomy. Using a minimally invasive technique, the surgeon makes a limited incision (4-6cm) in the right chest wall allowing access to the heart, valves, and great vessels. Employing this technique leads to reduced morbidity, shorter length of stay, and improved cosmetic appearance without compromising patient safety. This procedure is more attractive to patients and referring physicians due to the less invasive nature and abbreviated recovery. These benefits have made minimally invasive valve surgery the "standard of care" for isolated surgical valve procedures (both repair and replacement). Other Valve Disease The tricuspid valve is the 3rd most commonly affected valve with degeneration secondary to rheumatic, endocarditis, or pulmonary hypertensive processes. This valve can most often be repaired. Often multiple valves will need to be addressed during a single operation; for example, patients with rheumatic disease often have severe dysfunction of both aortic and mitral valves.