VALVULAR HEART DISEASE Introduction

VALVULAR HEART DISEASE Introduction

Early surgical management of valvular heart disease concen - trated on valve repair. The heroic early procedures for valve stenosis were closed and therefore ‘blind’ commissurotomies

® Figure 59.8 Off-pump coronary artery bypass using an Octopus stabiliser to perform the distal anastomosis.

procedures with full visualisation, allowing precise repair and replacement. The first prosthetic valve replacement was performed by Dwight Harken, who replaced an aortic valve, followed by a mitral valve replacement by Starr a year later. Continued improvements in perioperative care, myocardial protection and, in particular, the development of prosthetic heart valves have improved long-term haemodynamic results, provided symptom relief and prolonged survival. The majority of valvular operations involve surgery on the aortic or mitral valve; tricuspid and pulmonary valve surgery is rarely under taken in isolation unless it is part of staged congenital surgery .