Surgeon Q&A: Aortic Valve Repair & Valve Sparing Aortic Root Replacement with Dr. Ali Khoynezhad

Together, we have learned about many different types of surgical procedures used to treat heart valve disease and related cardiac disorders including coronary artery disease, atrial fibrillation and aortic aneurysms.

Two procedures that I'm continuing to hear about these days are aortic valve repair and valve-sparing aortic root replacement. To learn more about these unique approaches to aortic valve disease and aortic aneurysms, I recently connected with Dr. Ali Khoynezhad who is the Director of Aortic Surgery at Cedars-Sinai in Los Angeles, California. As you can see here, Dr. Khoynezhad has successfully treated 18 patients from this website.

Video Transcript of My Interview with Dr. Ali Khoynezhad

For the hearing impaired members of our community, you will find a written transcript of my interview with Dr. Khoynezhad below.

Dr. Khoynezhad: I am a Professor of Cardiovascular Surgery and Director of Aortic Surgery at Cedars-Sinai Medical Center. Over the last 13 years, I have performed 3,000 cardiovascular operations. Over 900 of them were heart valve operations. I was privileged to spend six months at Texas Medical Center -- early in my career. I had a scholarship to work with Dr. Cooley and Dr. DeBakey. These are giants in the cardiovascular field and interacting with them was outstanding. I knew I was going to be a cardiac surgeon. I like cardiac surgery because I can impact the care and the health of a patient -- dramatically and immediately. That's a wonderful experience. I love it.

Dr. Ali Khoynezhad - Heart Surgeon

I do perform the entire spectrum of heart valve replacement and repair, but I specialize in aortic valve repair and valve sparing aortic root replacement.

In an aortic valve repair, you preserve the patient's own valve and reconstitute the functional anatomy so the valve becomes competent again. It's a very gratifying experience because a well-done valve repair is always superior than a valve replacement.

Valve repair has many distinct advantages compared to valve replacement. One of them is it has reduced thromboembolic events. These are events which can cause stroke in patients. The patient with valve repair that does not require anti-coagulation (e.g. blood thinners like Coumadin). They also have a lower infection rate, and the hemodynamic profile of valve repair is always superior than any valve replacement. In addition, there are some studies that suggest that patient who have valve repair may live longer than patient who have valve replacement.

David Procedure (Valve Sparing)

There are many techniques for repairing the aortic valve. We can categorize them in three different sections:

• The first one has to do with reducing and fixation of aortic valve annulus or sinotubular junction.

• The second category concentrates on repairing the cusp itself -- such as cusp extension, adjusting the margin of aortic cusps, closure of little holes that happen naturally on the aortic valve.

• Third, and last but not least, is the valve-preserving aortic root replacement. The David Procedure is the most commonly performed valve-preserving aortic root operation. We reduce the annulus of the aortic valve diameter. We also re-implant the valve within the Dacron graft and then hook up the coronary arteries back to the Dacron graft. This represents particularly a reconstructed aortic root.

My advice for patients is three-fold. First, they need to have a good, quality echocardiogram before the surgery. We need to understand what's the functional anatomy of the valve, what's the pathology, why is the valve leaking, and how we can approach the repair. Second, they need to choose a surgeon carefully. You need a high-volume surgeon with experience in aortic valve repair. Third, you need to choose an institution that has a good infrastructure and has great anesthesiologists as well as critical care doctor and nurses for good recovery.

Cedars-Sinai is the largest academic heart valve program in the West Coast. There are a few centers in the country or a handful of centers in the country that can compete with the volume as well as the spectrum offered at Cedars-Sinai. I think for patients who require heart valve surgery, Cedars Sinai has the entire breadth of operations.

I hope this helped you learn more about aortic valve repair and valve sparing aortic root reconstruction including the David Procedure. Many thanks to Dr. Ali Khoynezhad for sharing his clinic experiences and research with our patient and caregiver community.

• To learn more about Dr. Khoynezhad, click here.

Keep on tickin!