Aortic valve stenosis: Should I have surgery? - Quest Diagnostics Patient Health Library

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. Most people who have symptoms of severe aortic valve stenosis die within 2 to 5 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, such as:

Chest pain (angina) or discomfort, often described as a heavy, tight feeling in the chest or a burning, choking, or squeezing that may spread to the arms, shoulders, or neck. Chest pain can happen when you exert yourself, since this is when your heart works hardest.
Feeling dizzy, feeling faint, or passing out (losing consciousness), often after an activity.
Signs of heart failure, such as tiredness and shortness of breath with activity.
A fast or irregular heartbeat (arrhythmia).
Palpitations (feeling like your heart is pounding or racing).

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 procedure that makes the valve opening bigger. It may be an option for children, teens, or young adults in their 20s who were born with a bicuspid aortic valve (which has two flaps instead of three). 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.³

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 severe symptoms of stenosis.
You are not having symptoms but are having open-chest surgery for another heart problem.

2. Compare 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 3 to 6 weeks to recover at home.	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 5 years.¹

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Aortic Valve Stenosis.

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 exam. 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

3. Your Feelings

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 severe 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:

More important

Equally important

More important

4. Your Decision

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. Quiz Yourself

Check the facts.

1. If you have severe symptoms of aortic valve stenosis, what is the only treatment to fix your aortic valve?

Taking medicine
Having surgery to replace the aortic valve
I'm not sure

You're right. Having surgery to replace the aortic valve is the only treatment to fix aortic valve stenosis if you have severe symptoms.

2. If you have severe symptoms of aortic valve stenosis but have no other health problems, which treatment carries greater risks?

Having valve replacement surgery
Not having valve replacement surgery
I'm not sure

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?

Go ahead and replace the aortic valve
Wait to replace the aortic valve
I'm not sure

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.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Stewart WJ, Carabello BA (2007). Aortic valve disease. In EJ Topol et al., eds., Textbook of Cardiovascular Medicine, 3rd ed., pp. 366–388. Philadelphia: Lippincott Williams and Wilkins.
Bonow RO, Braunwald E (2004). Aortic stenosis section of Valvular heart disease. In E Braunwald et al., eds., Heart Disease, 7th ed., vol. 2, pp. 1582–1592. Philadelphia: Saunders.
Aikawa K, Otto C (2001). Timing of surgery in aortic stenosis. Progress in Cardiovascular Diseases, 43(6): 477–493.