Difficulties of treating aortic valve stenosis
It is important that you take an active role in your treatment to help to prevent difficulties arising from aortic valve stenosis.
What are the risks of delaying valve replacement surgery?
If you do not replace your aortic valve soon after you develop symptoms of stenosis, you are at risk for developing serious complications, in particular heart failure. There are a number of reasons why valve replacement surgery may be unnecessarily delayed, which can allow time for complications to develop:
- Failure to notice symptoms. The onset of symptoms of stenosis can be slow, and often people do not even realize that they are experiencing symptoms. For example, you may discount shortness of breath as "being out of shape" or "getting older," or you might discount chest pain as heartburn. Alternatively, you may unconsciously avoid activities that bring on symptoms, such as climbing the stairs.
- Failure to report symptoms. Even when people with aortic valve stenosis do notice symptoms, they do not always report them to their doctors, either because they do not have time or they are reluctant to face the prospect of surgery or any other consequences of symptoms.
- Failure to probe for symptoms. When people with aortic valve stenosis come in for a periodic checkup, some doctors are not thorough in probing for evidence of symptoms, especially in cases where people may not realize they have symptoms or have been avoiding activities that bring on symptoms.
- Failure to schedule surgery promptly. Because valve replacement surgery is an elective procedure, surgery may be scheduled at a time that is convenient for you. Either because of fear of surgery or lack of time in their schedules, some people may delay surgery too long and allow complications to develop.
Despite these pitfalls, it is extremely important that you and your doctor make every effort to ensure that the valve is replaced when necessary.
What are the risks of choosing the wrong type of replacement valve?
There are a number of important potential valve mismatches that you and your doctor should be wary of when choosing the replacement valve. While the choice of replacement valve may be largely the decision of your heart surgeon, to the extent that you do have a degree of choice, you should be aware of these potential mismatches.
In certain cases, the following valve choices may be appropriate, but generally speaking they are not the optimal choices:
- A tissue valve for a young person. Tissue valves have a high rate of failure in younger people, often resulting in complications or the need for a repeated valve replacement. Despite the burden of taking medication to prevent blood clots (blood thinners), younger people who need to have their aortic valve replaced generally benefit most from the durability of mechanical valves. While stentless porcine (from pigs) valves are promising, their long-term durability has yet to be proven.
- A mechanical valve for an older person. For many older people receiving a replacement valve, the risk of taking blood-thinning medication for a mechanical valve is more significant than the likelihood that a tissue valve will last only 10 to 15 years. In addition, tissue valves tend to last much longer in older people than they do in younger people.
- A stented valve for a person with a small valve. If your natural aortic valve is very small, which is often the case in older women, a stented tissue valve may not allow for adequate blood flow. Although some stented tissue valves are better than others in this respect, you may want to consider a stentless tissue valve or a mechanical valve.
- A tissue valve for someone who is already taking medication to prevent blood clots. If you are already taking medication to prevent clots for another implanted device or another medical condition, such as an irregular heartbeat, there is little advantage in getting a tissue valve. Mechanical valves last much longer than tissue valves and are generally more reliable, making them the best choice if you are already taking blood-thinning medication.
What are the risks of not taking medications after surgery?
Many people who receive mechanical replacement valves understandably find it challenging to take medication every day, essentially for the rest of their lives. Keeping track of daily doses can be difficult, especially with a hectic schedule. People who take blood-thinning medication may also be concerned about the risk of excessive bleeding that is always present and that can limit their activities. Taking this medication requires people to be constantly careful. There are also the potential side effects, possible interactions with other medications, and the need for periodic blood tests to monitor the dosage.
Despite all these drawbacks, however, it is extremely important that you continue taking blood-thinning medication as prescribed if you have a mechanical replacement valve. The risk of blood clots that can cause a stroke or other complications is too great to ignore. If you are having trouble taking blood-thinning medication, you should ask your doctor for advice about how you can better live with your medication.
| Author: | Robin Parks, MS | Last Updated: November 14, 2007 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine George Philippides, MD - Cardiology | |
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