Aortic Valve Stenosis
Surgery
Your doctor will likely recommend valve replacement surgery if you have symptoms of aortic valve stenosis, unless you have other conditions that make surgery too risky. Symptoms such as chest pain, fainting, and shortness of breath indicate that you have severe narrowing of your aortic valve. If you do not have surgery to replace the valve, you will have a much shorter life span. In rare cases, you could die suddenly.
Most of the time, valve replacement surgery is a straightforward procedure with a high rate of success and a low risk of complications.
Aortic valve replacement
Aortic valve replacement is either an open-heart procedure or a minimally invasive procedure. In an aortic valve replacement surgery, the damaged valve is removed and replaced with an artificial valve (mechanical or tissue). View a slideshow on aortic valve replacement surgery
. Several different types of replacement valves are available. For more information about types of replacement valves, see:
In rare cases, the aortic valve may be replaced with one of your other heart valves. Usually the pulmonic valve is used. This valve is located between the lower right heart chamber and the opening to the artery that goes to the lungs. An artificial valve is used to replace the pulmonic valve. This type of valve surgery may be used in people younger than 25 who stand to benefit the most from this difficult surgery. The pulmonic valve is more durable, grows with the person, and has a lower risk of infection.
Valve replacement surgery is high-risk for people who either have a failing left ventricle, coronary artery disease, or have had a heart attack.
Medical experts debate whether valve replacement surgery should be done for aortic valve stenosis that is not causing symptoms. Although no current research supports this approach, some doctors believe that repair or replacement surgery should be done as soon as severe stenosis is found because of the small risk of sudden death.
Other doctors believe surgery isn't necessary until symptoms develop. These doctors believe that the risk of sudden death is less than the risks of surgery. If surgery is delayed, regular follow-up exams (including echocardiograms) are needed to monitor changes in the valve structure and heart function. These tests may indicate when surgery is needed.
In most cases, if you have symptoms, the risk of not replacing the valve is higher than the risk of having surgery. The majority of people who have symptoms of severe aortic valve stenosis die within 2 to 5 years if they do not have valve replacement surgery.2
The risk of surgery is higher than average for people who have severe aortic valve stenosis, failure of the left ventricle, and a low ejection fraction. But one study has found that even people in this higher-risk group benefit from valve replacement. Valve replacement surgery is also high-risk for people who have coronary artery disease or have had a heart attack.
Before having valve replacement surgery, your doctor may suggest you have a coronary angiogram/catheterization test. This test can show if you have blockages in your coronary arteries (as part of coronary artery disease). If you have serious blockages, your doctor may want to do a coronary artery bypass surgery at the same time as the valve replacement surgery.
Other aortic valve surgery
Balloon valvuloplasty may be an option for some younger people who have aortic valve stenosis. Although the heart valve is not replaced, the narrowed opening is made larger during this procedure.
What to think about
Should I have surgery to replace my aortic valve?
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| 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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