Aortic Valve Stenosis: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Aortic Valve Stenosis: Should I Have Surgery?
Get the facts
Your options
- Have surgery to replace your aortic valve.
- Don't have surgery.
This decision is more complex if you have severe
aortic valve stenosis but don't have any symptoms. If
you don't have symptoms, your doctor may not advise valve replacement unless
you are having heart surgery for another health problem.
Key points to remember
- Replacing the aortic valve is the only treatment that will fix
the valve when you have
aortic valve stenosis. Your doctor may prescribe
medicines to treat your symptoms, but they won't fix the valve.
- If you have severe symptoms, the risks of not replacing the
valve are greater than the risks of surgery unless you have other health
problems that make surgery too dangerous.
- If you have symptoms but don't have the valve replaced, your
life may be much shorter. People who have symptoms of aortic valve stenosis have a high risk of sudden death. On average, people may die within 2 to 3 years if they don't have valve replacement surgery.1
- Valve replacement surgery has a high rate of success and a low
risk of causing other problems if you are otherwise healthy.
- Valve
replacement surgery is high-risk for people who have a failing left ventricle
or
coronary artery disease or have had a heart
attack.
- If you do not have symptoms, your doctor may suggest that
you wait until after symptoms occur to replace the valve.
FAQs
Aortic valve
stenosis is a narrowing of the
aortic valve. The aortic valve allows blood to flow from the heart's lower left
chamber (ventricle) into the
aorta and to the body. Stenosis prevents the valve
from opening properly, forcing the heart to work harder to pump blood through
the valve. This causes pressure to build up in the left ventricle and thickens
the heart muscle.
Your heart can make up for aortic valve stenosis
and the extra pressure for a long time. But at some point, it won't be able to
keep up the extra effort of pumping blood through the narrowed valve. This can
lead to
heart failure.
Aortic valve stenosis gets worse slowly. For many years you may not feel
any symptoms. But at some point, the valve will become so narrow that symptoms
occur. Symptoms are often brought on
by exercise, when the heart has to work harder. Symptoms include:
- Chest pain or pressure (angina). You
may have a heavy, tight feeling in your chest.
- Feeling dizzy or
faint.
- Feeling tired and being
short of breath.
- A feeling that your heart is
pounding, racing, or beating unevenly (palpitations).
After you start to have symptoms, surgery to replace the aortic valve is
the only treatment that will fix the valve. Your doctor may prescribe
medicines to treat your symptoms, but they won't fix the valve.
Balloon valvuloplasty is a less invasive procedure that makes the
valve opening bigger. It may be an option for some children, teens, or young adults
in their 20s. Sometimes it is
used as a short-term fix for people who are older or very ill, when open-heart
surgery would be too great a risk.
Timing is important. If you have valve surgery too soon,
you face the risks of surgery before you need to. And you also increase the
chance that you will need another new valve in the future. Even mechanical
valves, which last the longest, can wear out after 20 to 30 years. But if you
wait too long to have surgery, your heart may become damaged, leading to heart
failure.
Some people may benefit from surgery before they have
symptoms. In people who are at risk for sudden death, valve replacement surgery
may help. But sudden death is very rare before symptoms start, and it is
impossible to know when it might occur. People who have low blood pressure when
they exercise, serious problems with their left ventricle because of aortic
stenosis, or a very narrow valve are at a higher risk of sudden death.
Valve replacement
surgery has a high rate of success and a low risk of causing other problems if
you are otherwise healthy.
If you have severe symptoms, the risks of not replacing the valve are greater than the risks of surgery unless you have other health problems that make surgery too
dangerous.
In people who do not have left ventricular heart
failure, the risk of death from surgery ranges from 2% to 5%.2 That means that out of 100 people who have the surgery, 2 to
5 people will die and 95 to 98 people will live.
The risk is lower
for people who have the surgery when they are younger than 70. Out of 100 of
these people, 1 will die and 99 will live. The risk of death is higher in
people who have left ventricular heart failure and other signs that their heart
is not working well.2
Even if valve
replacement surgery is a success, you may have problems after surgery, such
as:
- An increased risk of blood clots. These can break off and cause a
stroke or
heart attack. You will need to take blood-thinning
medicines (anticoagulants) right after surgery to help prevent
blood clots. If you get a mechanical valve instead of a tissue valve, you will
need to take blood-thinners for as long as you have that
valve.
- A need for another replacement valve.
This will depend on the type of valve you get and how long you live after you
have the surgery.
- Incomplete relief from symptoms. Some types of valves do not have openings as wide as a normal
valve for a person your size. This can limit how well the valve works to
relieve your symptoms.
- A valve that fails.
There is a small chance that the valve will not work. Your doctor will need to
check from time to time to make sure that your valve is working.
After you have the new valve, you'll need to take
antibiotics to prevent an infection of the valve anytime you have certain other
procedures, such as dental work or another surgery.
Heart
surgery, such as valve surgery, also can cause an irregular heartbeat (atrial fibrillation). This can cause clots to form and
increases your risk of heart attack and stroke.
Most people who have symptoms of aortic valve stenosis are older than 65.
But your age shouldn't stop you from having valve replacement surgery.
There are other health problems that may
increase the risks of surgery, though. These include
coronary artery disease,
heart failure, advanced cancer, and brain problems
because of a stroke. If you have other serious health problems, it's important
to think about whether surgery will improve your quality of life and your
chances of living a longer life.
Your doctor may advise you to have valve replacement
if:
- You have symptoms of
stenosis.
- You are not having symptoms but are having open-chest
surgery for another heart problem.
Compare your options
|
|
|
|
What is usually involved?
|
|
|
|
What are the benefits?
|
|
|
|
What are the risks and side effects?
|
|
|
Have surgery to replace
your aortic valve Have surgery to replace
your aortic valve
- The surgery can take 2 to 5 hours. You will stay in the hospital
4 to 5 days after surgery. You will have a big scar on your chest from the
incision.
- It can take several weeks to recover.
- It is the only treatment that will fix the valve.
- You
may live longer.
- Valve replacement surgery has a high rate of success and a low
risk of causing other problems, if you are otherwise healthy.
- All surgery has risks, including the risks of anesthesia and
bleeding.
- The risk of dying from this surgery ranges from 2% to 5%.
This means that out of 100 people who have the surgery, 2 to 5 people will die
and 95 to 98 people will live.2
- The surgery is high-risk if you have a failing left ventricle or
coronary artery disease or if you have had a heart attack.
Do not have surgery
Do not have surgery
- You may take medicines to treat your symptoms.
- You avoid the risks of surgery.
- If you don't have
symptoms, you avoid having surgery too soon and maybe needing another valve
replacement later.
- If you wait too long to have surgery, your heart may become
damaged, leading to heart failure.
- Medicines can treat symptoms,
but they won't fix the valve.
- If you have symptoms and don't have
surgery, you are more likely to die within 2 to 3 years.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
A few days
ago, I began to notice how out of breath I am just walking up a few stairs in
my house. I've also been having some chest pain. I visited my doctor and found
that I have a severely narrowed aortic valve. Apparently I have had it for
years, but it's just now become bad enough that I'm having symptoms. My doctor
said I should have my valve replaced. I don't want to develop permanent heart
damage from this.
My doctor heard a heart murmur during a
routine physical examination. I had an echocardiogram and found out that I have mild
aortic stenosis. I feel fine. I don't have any chest pain or shortness of
breath. My doctor said it could be many years before I have symptoms, if at
all. So we agreed that I would have an echo every 3 years to keep an eye on it.
And I will make sure to report any symptoms.
I have
moderate aortic stenosis. It was discovered during some tests I had for
coronary artery disease. I'm scheduled to have coronary bypass surgery. My
cardiologist suggested that I have a new aortic valve put in at the same time I
have the bypass surgery. That way I only have to have one open-heart operation.
I've known for years that I have aortic
stenosis. I'm now in the severe stage as far as the width of the valve opening.
But so far, I don't have any symptoms. My doctor says I should wait until I
have symptoms before having surgery. My health is fine otherwise. I take lots
of walks and ride my bike, but I am careful not to do anything extremely
strenuous. I'll call my doctor the minute I have any symptoms of chest pain,
fainting, or shortness of breath.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to replace your aortic valve
Reasons not to have surgery
I have symptoms of aortic valve stenosis.
I don't have symptoms.
More important
Equally important
More important
I don't have symptoms yet, but I need major surgery for another heart problem.
I'm not planning to have any other type of heart surgery.
More important
Equally important
More important
Surgery is my only chance to live a longer life.
I have other health problems, and I don't think this surgery will help me live longer.
More important
Equally important
More important
For me, the benefits of valve replacement outweigh the risks of the surgery.
I don't want to have surgery of any kind.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery
NOT having surgery
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1.
If you have symptoms of aortic valve stenosis, what is the only treatment to fix your aortic valve?
2.
If you have severe symptoms of aortic valve stenosis but have no other health problems, which treatment carries greater risks?
3.
If you have aortic valve stenosis but no symptoms, what might your doctor suggest?
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Credits |
Healthwise Staff |
| Primary Medical Reviewer |
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Specialist Medical Reviewer |
John A. McPherson, MD, FACC, FSCAI - Cardiology |
References
Citations
- Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
e523–e661.
- Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Aortic Valve Stenosis: Should I Have Surgery?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Have surgery to replace your aortic valve.
- Don't have surgery.
This decision is more complex if you have severe
aortic valve stenosis but don't have any symptoms. If
you don't have symptoms, your doctor may not advise valve replacement unless
you are having heart surgery for another health problem.
Key points to remember
- Replacing the aortic valve is the only treatment that will fix
the valve when you have
aortic valve stenosis. Your doctor may prescribe
medicines to treat your symptoms, but they won't fix the valve.
- If you have severe symptoms, the risks of not replacing the
valve are greater than the risks of surgery unless you have other health
problems that make surgery too dangerous.
- If you have symptoms but don't have the valve replaced, your
life may be much shorter. People who have symptoms of aortic valve stenosis have a high risk of sudden death. On average, people may die within 2 to 3 years if they don't have valve replacement surgery.1
- Valve replacement surgery has a high rate of success and a low
risk of causing other problems if you are otherwise healthy.
- Valve
replacement surgery is high-risk for people who have a failing left ventricle
or
coronary artery disease or have had a heart
attack.
- If you do not have symptoms, your doctor may suggest that
you wait until after symptoms occur to replace the valve.
FAQs
What is aortic valve stenosis?
Aortic valve
stenosis is a narrowing of the
aortic valve . The aortic valve allows blood to flow from the heart's lower left
chamber (ventricle) into the
aorta and to the body. Stenosis prevents the valve
from opening properly, forcing the heart to work harder to pump blood through
the valve. This causes pressure to build up in the left ventricle and thickens
the heart muscle.
Your heart can make up for aortic valve stenosis
and the extra pressure for a long time. But at some point, it won't be able to
keep up the extra effort of pumping blood through the narrowed valve. This can
lead to
heart failure.
What are the symptoms of aortic valve stenosis?
Aortic valve stenosis gets worse slowly. For many years you may not feel
any symptoms. But at some point, the valve will become so narrow that symptoms
occur. Symptoms are often brought on
by exercise, when the heart has to work harder. Symptoms include:
- Chest pain or pressure (angina). You
may have a heavy, tight feeling in your chest.
- Feeling dizzy or
faint.
- Feeling tired and being
short of breath.
- A feeling that your heart is
pounding, racing, or beating unevenly (palpitations).
Is surgery the only treatment for aortic valve stenosis?
After you start to have symptoms, surgery to replace the aortic valve is
the only treatment that will fix the valve. Your doctor may prescribe
medicines to treat your symptoms, but they won't fix the valve.
Balloon valvuloplasty is a less invasive procedure that makes the
valve opening bigger. It may be an option for some children, teens, or young adults
in their 20s. Sometimes it is
used as a short-term fix for people who are older or very ill, when open-heart
surgery would be too great a risk.
Why is it important to wait for symptoms to occur before having surgery?
Timing is important. If you have valve surgery too soon,
you face the risks of surgery before you need to. And you also increase the
chance that you will need another new valve in the future. Even mechanical
valves, which last the longest, can wear out after 20 to 30 years. But if you
wait too long to have surgery, your heart may become damaged, leading to heart
failure.
Some people may benefit from surgery before they have
symptoms. In people who are at risk for sudden death, valve replacement surgery
may help. But sudden death is very rare before symptoms start, and it is
impossible to know when it might occur. People who have low blood pressure when
they exercise, serious problems with their left ventricle because of aortic
stenosis, or a very narrow valve are at a higher risk of sudden death.
What are the risks of surgery?
Valve replacement
surgery has a high rate of success and a low risk of causing other problems if
you are otherwise healthy.
If you have severe symptoms, the risks of not replacing the valve are greater than the risks of surgery unless you have other health problems that make surgery too
dangerous.
In people who do not have left ventricular heart
failure, the risk of death from surgery ranges from 2% to 5%.2 That means that out of 100 people who have the surgery, 2 to
5 people will die and 95 to 98 people will live.
The risk is lower
for people who have the surgery when they are younger than 70. Out of 100 of
these people, 1 will die and 99 will live. The risk of death is higher in
people who have left ventricular heart failure and other signs that their heart
is not working well.2
Even if valve
replacement surgery is a success, you may have problems after surgery, such
as:
- An increased risk of blood clots. These can break off and cause a
stroke or
heart attack. You will need to take blood-thinning
medicines (anticoagulants) right after surgery to help prevent
blood clots. If you get a mechanical valve instead of a tissue valve, you will
need to take blood-thinners for as long as you have that
valve.
- A need for another replacement valve.
This will depend on the type of valve you get and how long you live after you
have the surgery.
- Incomplete relief from symptoms. Some types of valves do not have openings as wide as a normal
valve for a person your size. This can limit how well the valve works to
relieve your symptoms.
- A valve that fails.
There is a small chance that the valve will not work. Your doctor will need to
check from time to time to make sure that your valve is working.
After you have the new valve, you'll need to take
antibiotics to prevent an infection of the valve anytime you have certain other
procedures, such as dental work or another surgery.
Heart
surgery, such as valve surgery, also can cause an irregular heartbeat (atrial fibrillation). This can cause clots to form and
increases your risk of heart attack and stroke.
If you are older, should you still have surgery?
Most people who have symptoms of aortic valve stenosis are older than 65.
But your age shouldn't stop you from having valve replacement surgery.
There are other health problems that may
increase the risks of surgery, though. These include
coronary artery disease,
heart failure, advanced cancer, and brain problems
because of a stroke. If you have other serious health problems, it's important
to think about whether surgery will improve your quality of life and your
chances of living a longer life.
Why might your doctor recommend valve replacement surgery?
Your doctor may advise you to have valve replacement
if:
- You have symptoms of
stenosis.
- You are not having symptoms but are having open-chest
surgery for another heart problem.
2. Compare your options
| |
Have surgery to replace
your aortic valve |
Do not have surgery
|
| What is usually involved? |
- The surgery can take 2 to 5 hours. You will stay in the hospital
4 to 5 days after surgery. You will have a big scar on your chest from the
incision.
- It can take several weeks to recover.
|
- You may take medicines to treat your symptoms.
|
| What are the benefits? |
- It is the only treatment that will fix the valve.
- You
may live longer.
- Valve replacement surgery has a high rate of success and a low
risk of causing other problems, if you are otherwise healthy.
|
- You avoid the risks of surgery.
- If you don't have
symptoms, you avoid having surgery too soon and maybe needing another valve
replacement later.
|
| What are the risks and side effects? |
- All surgery has risks, including the risks of anesthesia and
bleeding.
- The risk of dying from this surgery ranges from 2% to 5%.
This means that out of 100 people who have the surgery, 2 to 5 people will die
and 95 to 98 people will live.2
- The surgery is high-risk if you have a failing left ventricle or
coronary artery disease or if you have had a heart attack.
|
- If you wait too long to have surgery, your heart may become
damaged, leading to heart failure.
- Medicines can treat symptoms,
but they won't fix the valve.
- If you have symptoms and don't have
surgery, you are more likely to die within 2 to 3 years.
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
Personal stories about aortic valve replacement surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"A few days ago, I began to notice how out of breath I am just walking up a few stairs in my house. I've also been having some chest pain. I visited my doctor and found that I have a severely narrowed aortic valve. Apparently I have had it for years, but it's just now become bad enough that I'm having symptoms. My doctor said I should have my valve replaced. I don't want to develop permanent heart damage from this."
"My doctor heard a heart murmur during a routine physical examination. I had an echocardiogram and found out that I have mild aortic stenosis. I feel fine. I don't have any chest pain or shortness of breath. My doctor said it could be many years before I have symptoms, if at all. So we agreed that I would have an echo every 3 years to keep an eye on it. And I will make sure to report any symptoms."
"I have moderate aortic stenosis. It was discovered during some tests I had for coronary artery disease. I'm scheduled to have coronary bypass surgery. My cardiologist suggested that I have a new aortic valve put in at the same time I have the bypass surgery. That way I only have to have one open-heart operation."
"I've known for years that I have aortic stenosis. I'm now in the severe stage as far as the width of the valve opening. But so far, I don't have any symptoms. My doctor says I should wait until I have symptoms before having surgery. My health is fine otherwise. I take lots of walks and ride my bike, but I am careful not to do anything extremely strenuous. I'll call my doctor the minute I have any symptoms of chest pain, fainting, or shortness of breath."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to replace your aortic valve
Reasons not to have surgery
I have symptoms of aortic valve stenosis.
I don't have symptoms.
More important
Equally important
More important
I don't have symptoms yet, but I need major surgery for another heart problem.
I'm not planning to have any other type of heart surgery.
More important
Equally important
More important
Surgery is my only chance to live a longer life.
I have other health problems, and I don't think this surgery will help me live longer.
More important
Equally important
More important
For me, the benefits of valve replacement outweigh the risks of the surgery.
I don't want to have surgery of any kind.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery
NOT having surgery
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1.
If you have symptoms of aortic valve stenosis, what is the only treatment to fix your aortic valve?
You're right. Having surgery to replace the aortic valve is the only treatment to fix aortic valve stenosis if you have symptoms.
2.
If you have severe symptoms of aortic valve stenosis but have no other health problems, which treatment carries greater risks?
You're right. If you have severe symptoms, the risks of not replacing the valve are greater than the risks of surgery, if you have no other health problems.
3.
If you have aortic valve stenosis but no symptoms, what might your doctor suggest?
You are right. If you don't have symptoms, your doctor may suggest that you wait until after symptoms occur to have surgery.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Specialist Medical Reviewer |
John A. McPherson, MD, FACC, FSCAI - Cardiology |
References
Citations
- Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
e523–e661.
- Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised:
November 2, 2011
Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
e523–e661.
Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
