DR. MARK J. RUSSO, MD, MS
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(732) 235-7231
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Aortic Valve Repair and Replacement


TREATMENTS | Antegrade Cerebral Perfusion | Aortic Valve Repair and Replacement |  Endovascular Stent Graft and Hybrid Procedures | Homograft | Minimally Invasive Aortic Surgery | Transcatheter Valve Therapies | Valve-Sparing Root

When heart valves are severely malformed or damaged, there is no medicine to reverse or repair the damage.  In most cases, surgery is the only effective option for repairing the valve and and alleviating symptoms.  

Heart valve repair: Heart valve repair surgery attempts to preserve the patients native valve.  It may  include cutting scarred flaps so they open more easily; remodeling valve tissue that has enlarged; or inserting prosthetic rings to help narrow a dilated valve.  Because a person's own tissues are used, heart valve repair is possible for aortic regurgitation.  

 
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Valve Sparing Root, also known as the David Procedure is a commonly used aortic valve repair technique.  When the aorta is dilated, but the aortic valve is structurally otherwise normal, the aorta can be replaced ("root replacement") while preserving the aortic valve ("valve sparing"). This avoids the need for a valve replacement with an artificial valve.  Thus offering the possibility for a more durable repair, as well as avoiding the potential need for blood thinning medication. 
Heart valve replacement:  In some cases, particularly for aortic stenosis, heart valve replacement is necessary. When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves:
 
 
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Mechanical valves are made of  metal, plastic, or another artificial material and thus have greater durability.   The downside is that it requires the patient to remain on anticoagulation for the rest of their life.  They are traditionally recommended for patients:        
  •  < 60 years old
  •  patients who want to avoid reoperation
  • patients are already on long-term anticoagulation for another reason 
 
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Tissue valves do not require long-term anticoagulation, but they are less durable.  They are traditionally recommended for patients: 
  • > 60 years old
  • patients who prefer to avoid anticoagulation for lifestyles reasons (eg extremely active lifestyle, recent GI bleed, childbearing age)  
However durability of a tissue valve is age dependent, due to greater hemodynamic demands in younger PATIENTS. Structural valve deterioration in patients at 10 years:
  • 0-40yo: 40%
  • 40-69yo:  30%
  • >70yo: 10%

What is transcatheter aortic valve replacement (TAVR)? 

Percutaneous and catheter based procedures are available for patients who are not candidates for surgical replacement or are extremely high risk for surgery.

Transcatheter aortic valve implantation (TAVI) is also know as  Transcatheter aortic valve replacement (TAVR).  Using an approach similar to the approach used for cardiac catheterization of the coronary arteries, TAVI involves a puncture though the skin into the blood vessels in the groin.  A catheter, about as wide as a pencil, is then threaded up through vessels in the leg into the aorta then into the heart.  A special valve is compressed and inserted into position though the tip of this thin catheter.  This approach avoids the need for opening the chest or using a heart lung machine.  

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Candidates for this percutaneous procedure include patients with severe symptomatic aortic stenosis and are deemed extremely high risk for surgery or inoperable by a heart surgeon.  Typically no single factor makes a patient too high risk for surgery.  Candidates typically have one or more of the following characteristics:  advanced age, previous heart surgery, severe COPD, severe diabetes, home oxygen dependence, pulmonary hypertension, previous radiation to the chest, a severely calcified aorta (aka a porcelain aorta), and/or extreme frailty. 
The New England Journal of Medicine recently reported that, in patients with severe symptomatic aortic stenosis who are not candidates for surgery, TAVI (aka TAVR) is associated significantly improved survival, improved symptoms, and improved quality of life compared to standard treatment.  In fact, patients undergoing TAVI were nearly twice as likely to be alive at 1 year compared with those who did not.    

Information for Patients 

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Transcatheter Aortic Valve Replacement for Patients Who Cannot Have Open-Heart Surgery (courtesy of Edwards Lifesciences)   

Information for Physicians

Candidacy for Transcatheter Aortic Valve Replacement  Reference Card   

Animation of 
TAVR Procedure

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Watch an animation of TAVI 

A Patient Experience with TAVR

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Listen to Connie discuss her experience with TAVI 
Appointment - 732-235-7231
​Patients:   We are committed to providing you with an appointment within 7 days of your request. For your convenience, Telemedicine Consults are available.   If you have questions in the meantime, please   Ask Our Experts.
Patient   Appointments   -  732-235-7231

​ Physicians:   Our team is available 24 hours a day, 7 days a weeks, to assist in the care of your patients and to facilitate urgent, emergent and elective transfers at the local, regional, national and international levels​
RWJUH Transfer Center   -   732-427-5725
About Dr. Russo
Telemedicine
Aortic Aneurysms
Minimally Invasive Surgery
TAVR
Mitraclip
Clinical Trials

2nd Opinion
Ask Dr. Russo
Getting a second opinion can provide peace of mind and confidence that you have been diagnosed appropriately and understand of all your treatment options. 
​Send your non-urgent questions regarding your aortic,  heart, and vascular conditions via email.

Mark J Russo, MD, MS
 Chief, Cardiac Surgery

Director, Structural Heart Disease
Associate Professor of Surgery
​
​Rutgers-Robert Wood Johnson Medical School
Robert Wood Johnson
University  Hospital 
​125 Paterson St
​New Brunswick, NJ  ​08901

Office: 732-235-7231
Fax:   
732-235-8963​
Expert in Complex Aortic  Disease, Valve Surgery, Transcatheter Aortic Valve Repalcement (TAVR) , and Mitraclip
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(c) Mark Russo 2020
Dr. Russo performs the full range of cardiac surgery including  Coronary Artery Surgery - Coronary Artery Bypass Grafts; Bypass Surgery;  CABG;  Coronary Artery Surgery; Reoperation; Off Pump Bypass Surgery; Off Pump Heart Surgery; Valve Surgery - Aortic Valve Repair; Aortic Valve Replacement; Mitral Valve Repair; Mitral Valve Replacement ; Reoperatve Heart Valve Surgery;;  Endovascular and Hybrid Aortic Surgery;  Transcatheter Valve Surgery - TAVR, TAVI, ViV, MVIV, valve-in-valve; Minimally Invasive Cardiac Surgery - Minimally Invasive Mitral Valve Repair; Mitral Valve Replacement; Minimally Invasive Aortic Valve Surgery​; Aortic Surgery - Aorta Surgery; Aortic Dissection; Complex Aorta Surgery; Valve Sparing Roots, Heart Surgery for Marfan Syndrome; Aortic Root Aneurysms; Ascending Aortic Aneurysms; Aortic Arch Aneurysms; Descending Thoracic Aortic Aneurysms; Thoracoabdominal Aortic Aneurysms; Abdominal Aortic Aneurysms; Aortic Dissections, including Type A Dissections and Type B Dissections; Native Aortic and Prosthetic Graft Infections, including Endocarditis; Congenital Aortic Disease, such as Marfan's syndrome and Loeys Dietz; Transplant Surgery - Heart and Lung.  He was trained by Dr. Mehmet Oz and Craig Smith and Eric Rose.  Read about Matt Millen undergoing Heart Transplant