First, you must determine the severity of your condition. Valve
surgery is usually only performed 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
The percentage of blood that leaves the left ventricle with each pump
(ejection fraction) and the size of the left ventricle
at rest determine the severity of aortic valve regurgitation.
The American College of Cardiology/American Heart Association
(ACC/AHA) guidelines recommend having aortic valve replacement surgery if you
have severe regurgitation and one of the following conditions:1
You have symptoms.
Your ejection fraction drops below
50% at rest.
Your left ventricle enlarges to more than 55
millimeters at rest.
Your doctor may recommend that you have surgery even if you do not
have symptoms because symptoms typically only occur after the condition has
progressed to the point that it has already damaged the heart.
These guidelines mean that you may need to replace the valve before
you develop any symptoms. However, other risk factors including age, speed of
deterioration, and overall health will also be considered in deciding the
timing of surgery.
The more advanced your age and the poorer your overall health, the
greater the risk that you will not survive surgery. These risk factors may
cause you to delay surgery beyond the ACC/AHA guidelines. On the other hand, if
your valve is deteriorating rapidly, your doctor may consider surgery sooner or
may monitor your condition more frequently.
Assessing the possibility your condition will worsen
Another important question, along with the severity of
regurgitation, is how likely it is that your condition will worsen soon. Your
doctor will assess the progression of regurgitation by comparing the results of
your most recentechocardiogramwith your earlier echo results. If you
have mild regurgitation, your doctor will probably perform an echo every 3 or 4
years because regurgitation usually progresses slowly. However, if your echo
comparisons indicate that your regurgitation is worsening or your heart is
enlarging or not pumping enough blood, your doctor may order echocardiograms
more frequently. 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. However, if you have
other compounding factors, such as high blood pressure or coronary artery
disease (CAD) or both, the regurgitation is more likely to worsen soon, and
surgery may be necessary in the near term.
Risks of surgery
The severity of regurgitation and the likelihood it will worsen
need to be balanced against the risks involved with having a valve replacement
surgery. During the operation, your sternum (breastbone) will be separated,
which will require time to heal and may be uncomfortable during recovery. Your
heart will be stopped during surgery and cut open so that the valve can be
replaced. While your heart is stopped, the blood in your body will be pumped
and oxygenated by a heart-lung machine.
Although most people have successful outcomes, the risk of death
and serious problems during surgery is real. About 5% or less of people having
valve surgery die.2Risks of surgery need to be
weighed in the decision to replace the valve.
Sometimes other factors play a role in the decision to have
surgery. When open chest surgery is already planned-for instance,coronary artery bypass surgeryfor coronary artery
disease-then valve replacement is often done at the same time.
Second, while artificial valves are effective, they will wear out
faster than a human valve. Eventually all artificial valves will need to be
replaced if given a long enough period of time, and you will need to have valve
replacement surgery again. By waiting to replace your valve until regurgitation
is severe, you will limit the number of artificial valves and surgeries you
will need in your lifetime.
Why not valve reconstruction or repair?
Unfortunately, valve reconstruction and repair are not generally
viable treatments for aortic valve regurgitation. This is because of the very
high pressure in the left ventricle. The additional pressure makes repair
ineffective in the long term and replacement of the valve the only real
Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for
the management of patients with valvular heart disease. A report of the
American College of Cardiology/American Heart Association Task Force on
Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the
Management of Patients with Valvular Heart Disease).Circulation, 114(5): e84-e231.
Rahimtoola SH (2004). Aortic valve disease. In V
Fuster et al., eds.,Hurst's The Heart, 11th ed., vol.
2, pp. 1643-1667. New York: McGraw-Hill.
Robin Parks, MS
Kathleen M. Ariss, MS
Pat Truman, MATC
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
January 24, 2008
WebMD Medical Reference from Healthwise
January 24, 2008
This information is not intended to replace the advice of a doctor.
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