When Do You Need Surgery?

When the heart valves are seriously damaged and impairing blood flow to the rest of the body or causing heart muscle damage, surgery to replace the defective valve may be recommended. Shortness of breath, syncope (fainting), chest pain, and heart failure are common signs of aortic valve disease. These symptoms are warning signs that the heart is working too hard to pump blood-when these symptoms occur, surgery is usually warranted.

Testing to further determine if you need surgery should include an echocardiogram of the heart, as well as coronary angiography to assess for blockages in the coronary arteries.

These conditions are potentially serious impediments to heart function, often hindering or reversing the natural flow of blood through the heart. Failing to fix a diseased aortic valve can be life-threatening, and untreated patients have less than a 50% survival at 2-3 years.

To treat aortic valve disease, surgeons either repair the patient's own valve, or most commonly replace that valve with a tissue or mechanical substitute. Choosing between a bioprosthetic valve versus a mechanical valve is a complex decision that involves many lifestyle factors, age, and whether a patient is able to tolerate blood thinners for the rest of their life.

At Columbia, aortic valve replacement can be performed through a standard incision or a minimally invasive incision in certain patients.  The patient is placed on the heart-lung machine, and, after the valve is removed, a new place is sewn in its place.

Bioprosthetic Valve Patients in general can expect to be discharged from the hospital after 5-7 days, and can resume normal activity upon discharge. The heart typically recovers fully after surgery, and patients can be expected to have a normal life expectancy. Patients with a mechanical valve need to take a blood thinner for the rest of their life, while patients with a bioprosthetic valve often only need to take daily low-dose aspirin.

Dr. Craig Smith – Which patients might benefit from transcatheter aortic valve replacement?

Dr. Craig Smith – What are the risks of aortic valve replacement surgery?

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