Why it's done

Aortic valve disease treatment depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.

Types of aortic valve disease that may require treatment with aortic valve repair or replacement include:

• Aortic valve regurgitation: This occurs when blood flows backward through the aortic valve into the left ventricle each time the ventricle relaxes rather than in the normal, one-way direction from the ventricle to the aorta. Back flow may be caused by a dysfunctional or leaky valve. This may be due to deterioration of the valve, an abnormal valve shape present at birth (congenital heart disease) or by a bacterial infection.
• Aortic valve stenosis. The stenosis causes the aortic valve to become narrowed or obstructed, which makes it harder for the heart to pump blood into the aorta. This may be caused by congenital heart disease, thickening of the valve's closure flaps (leaflets) or post-inflammatory changes, such as those associated with rheumatic heart disease.
• Congenital heart disease. Having this may contribute to aortic valve regurgitation or stenosis, as well as result in other problems that prevent the aortic valve from working properly. For example, a person may be born with an aortic valve that doesn't have enough tissue flaps (cusps), the valve may be the wrong size or shape, or there may not be an opening to allow blood to flow normally (atresia).

For some people with mild aortic valve disease without symptoms, careful monitoring under a doctor's supervision may be all that's needed.

But in most cases, aortic valve disease and dysfunction get worse despite medical treatment. Most aortic valve conditions are mechanical problems that can't be successfully treated with medication alone. Such conditions eventually require surgery to reduce symptoms and your risk of complications, such as heart failure, heart attack, stroke or death due to sudden cardiac arrest.

Aortic valve repair or replacement?

The decision to repair or replace a damaged aortic valve depends on many things, including:

• The severity of your aortic valve disease
• Your age and overall health
• Whether you need heart surgery to correct another heart problem in addition to aortic valve disease, such as heart bypass surgery to treat coronary artery disease, so both conditions can be treated at once

In general, heart valve repair is usually the first choice because it is associated with a lower risk of infection, preserves valve strength and function, and reduces the need to take blood-thinning medications for the rest of your life, which may be necessary with certain types of valve replacement. For example, people with a hole in the valve's closure flaps (perforated valve leaflet) may be candidates for aortic valve repair rather than replacement, depending on the severity of their condition.

However, most valves cannot be repaired, and heart valve repair surgery is often harder to do than valve replacement. Your best option will depend on your individual situation, as well as the expertise and experience of your health care team.

Aortic valve repair and aortic valve replacement may be done through traditional open-heart surgery, which involves a cut (incision) in the chest, or by using minimally invasive methods, which involve smaller incisions in the chest or a catheter inserted in the leg or chest (transcatheter aortic valve replacement, or TAVR).

Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than traditional open-heart surgery.

What type of procedure you have depends on your individual situation, and your doctor will explain the benefits and risks of each option.

For example, some people with aortic valve disease may not be candidates for traditional open-heart surgery due to other health problems, such as lung or kidney disease, that would make the procedure too risky.

Many people with aortic valve disease also have coronary artery disease and may need heart bypass surgery to improve blood flow. Heart bypass surgery is normally performed through traditional open-heart surgery, so your aortic valve procedure would be performed the same way.