- Cigna Medicare
- Individual & Family Plans
- International Plans
- Offered Cigna Through Work?
- Find a Doctor
- Informed on Reform
- Health and Wellness »
- Cigna Home Delivery Pharmacy
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
- 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.
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:
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?
- 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.
- 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 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.
Maria Theresa, age 67
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.
Maddie, age 40
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.
Ralph, age 58
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.
Fred, age 70
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.
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.
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.
For me, the benefits of valve replacement outweigh the risks of the surgery.
I don't want to have surgery of any kind.
My other important reasons:
My other important reasons:
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.
NOT having surgery
What else do you need to make your decision?
Check the facts
If you have symptoms of aortic valve stenosis, what is the only treatment to fix your aortic valve?
- Taking medicineSorry, that's wrong. Having surgery to replace the aortic valve is the only treatment to fix aortic valve stenosis if you have symptoms.
- Having surgery to replace the aortic valveYou're right. Having surgery to replace the aortic valve is the only treatment to fix aortic valve stenosis if you have symptoms.
- I'm not sureIt may help to go back and read "Is surgery the only treatment for aortic valve stenosis?" If you have symptoms, valve replacement surgery is the only treatment to fix aortic valve stenosis.
If you have severe symptoms of aortic valve stenosis but have no other health problems, which treatment carries greater risks?
- Having valve replacement surgerySorry, that's wrong. If you have symptoms, the risks of not replacing the valve are greater than the risks of surgery, if you have no other health problems.
- Not having valve replacement surgeryYou'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.
- I'm not sureIt might help to go back and read "What are the risks of surgery?" If you have severe symptoms, the risks of not replacing the valve are greater than the risks of surgery.
If you have aortic valve stenosis but no symptoms, what might your doctor suggest?
- Go ahead and replace the aortic valveSorry, that's not right. If you don't have symptoms, your doctor may suggest that you wait until after symptoms occur to have surgery.
- Wait to replace the aortic valveYou are right. If you don't have symptoms, your doctor may suggest that you wait until after symptoms occur to have surgery.
- I'm not sureIt may help to go back and read "Why is it important to wait for symptoms to occur before having surgery?" If you don't have symptoms, your doctor may suggest that you wait until after symptoms occur.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
|Specialist Medical Reviewer||John A. McPherson, MD, FACC, FSCAI - Cardiology|
- 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.
Last Updated:November 2, 2011