Ways to Treat a Failing Aortic Valve

By

Marijke Vroomen Durning, RN

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Your heart is made up of four chambers that work together to provide blood to your body. Valves between each chamber control the blood flow, ensuring the blood doesn’t move backwards. The last valve, the aortic valve, controls how much blood leaves your heart. Sometimes, this valve fails, resulting in aortic valve disease. The aortic valve is the most prone to disease.

In aortic valve disease, two issues can arise: 1) the aortic valve can become narrowed, resulting in aortic valve stenosis; or 2) the leaflets or flaps in the valve don’t close tightly enough and blood flows back into the heart, which is called aortic valve regurgitation. Many people have aortic valve disease. You can be born with it or it can develop over time because of calcium build up or tissue scarring.

Treating a Failing Aortic Valve

How your doctor proposes to treat your failing aortic valve will depend on how severe your symptoms are and your overall health. If your symptoms are mild to moderate and you have no other risk factors, your doctor may choose to monitor you—to wait and see if the situation worsens. Some people don’t progress beyond those milder symptoms and don’t need any further treatment. If the symptoms are becoming severe or are interfering with your quality of life, your doctor may recommend surgery to repair or replace the failing valve.

Repairing a Failing Aortic Valve

Typically with aortic valve disease, the valve must be replaced outright. However, in some cases, the valve may be repaired as a temporary fix before replacement at a later date. To repair the valve, a surgeon will perform a balloon valvuloplasty.

This procedure is done through a catheter inserted into a major artery in your groin, called the femoral artery, which goes directly to the heart. Your surgeon threads the catheter to the aortic valve. Through the catheter, the surgeon positions a balloon in the valve and inflates it. Once it is fully inflated, the valve opening should widen. The balloon is then deflated and removed back through the catheter.

Replacing a Failing Aortic Valve

In most cases, valve replacement is necessary. In the past, the only way to replace a failing aortic valve was through surgery, called surgical aortic valve replacement (SAVR).

Surgical Aortic Valve Replacement

In SAVR, a surgeon may perform open-heart surgery, making a large incision in the chest and replacing the failing valve with an artificial or donated one. However, in recent years, surgeons have developed and refined more minimally invasive techniques: some patients may be a better fit for operations in which the surgeon makes small incisions in the chest, then uses a camera and special equipment or robotic arms to replace the valve.

Your surgeon can choose to use a mechanical valve or a tissue valve to replace your failing valve.

Mechanical valves are created with man-made materials and work as long-term replacements. Your surgeon removes the damaged valve and replaces it with the mechanical one. People who are given a mechanical valve usually must take blood-thinning medicines to reduce the risk of blood clots forming around the pieces of the valve.

Tissue valves can come from animals or a human organ donation. The advantage to a tissue graft is that blood thinners are not usually needed after surgery, but these valves do not last as long as mechanical valves and may need replacing as often as every 10 years.

For children and active adults, a surgeon may suggest the Ross procedure. With this approach, your aortic valve is replaced by your own pulmonary valve (a valve in another part of your heart). Then, your pulmonary valve is replaced by a donor tissue valve. The advantage to this procedure is the pulmonary valve is not under as much stress from the pumping heart as the aortic valve is, so a replacement valve won’t have to work as hard. Your own pulmonary valve, with your own heart tissue, will be stronger and can last longer as the aortic valve.

Transcatheter Aortic Valve Replacement

Not all patients are ideal candidates for SAVR. Those patients can still undergo valve replacement through a procedure called transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI). Doctors may recommend TAVR for people at intermediate to high risk of complications from open-heart surgery.

To perform the TAVR, the surgeon makes a small incision in your groin to access the femoral artery, as with the balloon valvuloplasty. In some cases, the surgeon may instead choose to make a small incision in the chest and enter through a large artery in the chest, or enter through the lowest part of the heart, called the apex. A flexible catheter is then threaded through the artery (or the apex) until it gets to the aortic valve. Using this catheter, the surgeon positions a deflated balloon and the new valve inside the old aortic valve. As the balloon is inflated, it pushes open the new valve, securing it into place and pushing the old valve aside. Once the new valve is set, the surgeon deflates the balloon, and removes it along with the catheter. The new valve begins working immediately.

Whether your doctor is going to repair or replace your failing aortic valve, you will need to follow the post-procedure instructions to heal properly and to ensure the repair lasts as long as possible. The idea of heart surgery can be frightening, but by discussing it with your doctor and working together, that failing valve may soon be history.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 7, 2017

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