Aortic Valve Regurgitation: Deciding About Surgery

Topic Overview

The major decision in treating aortic valve regurgitation is whether to have aortic valve replacement surgery and, if so, when to do it.

Your doctor will check the severity of your condition. Your doctor will also check your overall health to see if surgery is too risky for you. Then you and your doctor will weigh the benefits of surgery against the risks for you.

Why is surgery done?

Valve surgery is usually only done if regurgitation is severe and in danger of doing irreparable damage to your heart. The risk of surgery is justified if the regurgitation is severe enough to threaten the health of your heart or your life.

Your doctor will check many things to see if surgery is right for you. Your doctor will check:

• The severity of aortic valve regurgitation.
• Your symptoms, if you have any.
• Your ejection fraction (how much blood your heart is pumping out to your body).
• The size of your left ventricle.

Your doctor may recommend that you have surgery even if you don't have symptoms, because symptoms typically only occur after the condition has progressed to the point that it has already damaged the heart.

When should I have surgery?

The timing of valve replacement surgery might depend on how likely it is that your valve disease will get worse.

Your doctor will assess the progression of regurgitation by comparing the results of your most recent echocardiogram with your earlier results. How often you have an echocardiogram depends on the severity of your regurgitation. The faster the regurgitation progresses, the sooner you will need a valve replacement.

If your condition has been progressing slowly, you may be able to wait a little longer before having a valve replacement. But if you have other compounding factors, such as high blood pressure and coronary artery disease, the regurgitation is more likely to get worse soon, and surgery may be needed sooner.

If you are going to have bypass surgery, your doctor may recommend that you have your valve replaced at the same time.

What are the risks?

The severity of regurgitation and the likelihood it will get worse need to be balanced against the risks involved with having a valve replacement surgery.

Valve replacement surgery has a high rate of success and a low risk of causing other problems if you are otherwise healthy. But the surgery is an open-heart surgery.

Although most people have successful outcomes, there is a risk of death and serious problems during surgery. About 5% or less of people having valve surgery die.^{footnote 1}

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. If you have a mechanical valve, this risk is higher, so you will take an anticoagulant called warfarin (Coumadin).
• 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.
• A valve that fails. There is a small chance that the valve won't work. Your doctor will need to check from time to time to make sure that your valve is working.

Can I have surgery to repair my valve?

For most people, surgery to repair the aortic valve is not an option. This is because of the very high blood pressure in the left ventricle, which pumps blood to the rest of the body. The high blood pressure makes the repaired valve start leaking again.