“My doctor has recommended that I have heart valve surgery, but I'm afraid. Can I say no and still be okay?” I get this type of question quite frequently. My answer is that it depends on which valve is involved and how it affects your quality of life.
Heart valve problems are fairly common. Eight million Americans have mitral valve prolapse and for most of them it causes no symptoms and requires no medical treatment.
Even if you have a leaking mitral valve (mitral regurgitation) and your heart is somewhat enlarged—but your quality of life is okay—I would not recommend surgery. Treatment with lifestyle and nutritional interventions has enabled many of my patients with this condition to avoid surgery.
The aortic valve, however, is a different story. When I see a patient with a leaking or calcified aortic valve and the left ventricle is starting to increase in size, I would say have the surgery. Here’s why.
What Problems Can Affect the Aortic Valve?
The aortic valve lies between the left ventricle (the lower left chamber of the heart) and the aorta (the large artery that delivers blood from the heart to the rest of the body). It consists of three leaflets, or flaps, that open with each beat of the heart to let blood flow out of the ventricle and into the aorta, then close to prevent blood from flowing backward.
Two main problems can affect this valve:
- Aortic valve stenosis: The valve becomes narrowed or obstructed, making it more difficult for blood to flow through the valve into the aorta.
- Aortic valve regurgitation (aortic insufficiency): The flaps don't close properly, allowing blood to leak back into the left ventricle.
These disorders may be caused by a number of conditions, including congenital defects, infections, and age-related calcification that makes the valves stiffer.
Why Does It Matter?
When the aortic valve is not functioning properly, the heart must work harder to pump blood, which reduces blood flow throughout the body. Although this goes unnoticed in earlier stages, as it progresses you will begin to experience shortness of breath, fatigue, chest pain, irregular heartbeat, or other symptoms.
Aortic valve dysfunction also causes enlargement of the overworked heart. When the left ventricle becomes too dilated, it can't snap back, and the risk of heart failure increases. The prognosis of untreated disease is poor. Aortic insufficiency can also cause sudden death, especially during exercise. I've seen this happen many times in patients who refuse surgery.
That’s why I am much more aggressive about recommending surgery when it comes to the aortic valve. Advanced disease cannot be treated with medications or other therapies. When you have an aortic valve that restricts blood flow and an enlarged heart, surgery is your only option.
What Does Valve Replacement Surgery Involve?
Aortic valve replacement involves removing the damaged valve and replacing it with a new one. It can be performed in two ways:
- Surgical aortic valve replacement (SAVR): The surgeon opens the chest and separates the breastbone to access the heart and aorta. You are placed on a heart-lung bypass machine to keep blood and oxygen circulating so your heart can be stopped during the surgery.
- Transcatheter aortic valve replacement (TAVR): This less invasive option doesn’t require open-heart surgery or the heart-lung machine. The replacement valve is placed on a catheter that is snaked up an artery to the heart. The surgeon accesses it through small incisions in the chest and performs the procedure on a beating heart. Since the FDA broadened approval for TAVR in 2019, its use is rapidly increasing.
There are also two types of replacement valves:
- Mechanical valves: Manufactured valves made of durable materials generally last a lifetime—but you’ll be required to take a blood-thinning medication for the rest of your life to prevent blood clots.
- Biological valves: Made from cow, pig, or (less often) human tissue, these biocompatible valves are increasing in popularity. They don’t last as long—10–20 years on average—and may need to be replaced. However, they do not require the use of blood thinners.
Other Common Questions
How long does heart valve replacement surgery take? Open heart SAVR generally lasts three to five hours. Minimally invasive TAVR takes about an hour and a half.
What are the potential complications? Bleeding, pain, infection, and adverse reactions to anesthesia are potential complications of heart valve replacement surgery. Arrhythmias may crop up, and blood clots can form that may lead to strokes, heart attacks, or lung problems. Cognitive dysfunction (confusion, memory loss, etc.) is also associated with open-heart surgery and may be a complication of the heart-lung bypass pump. Overall, however, a 2019 study suggests that TAVR and SAVR have similar outcomes in terms of efficacy and safety.
How dangerous is heart valve replacement surgery? No surgical procedure is without risk. However, the most serious complications, including death, are relatively rare, and most patients do well after surgery. Risks of heart valve replacement surgery aside, remember that untreated advanced aortic valve disease is associated with progressive, often fatal heart failure and sudden death.
What about recovery from heart valve replacement surgery? The average hospital stay following SAVR is five to seven days and fewer than three days for TAVR. You’ll have some weakness, fatigue, and pain, especially after open-heart surgery as your chest incision heals.
Follow your doctor’s orders for medications, resuming activities, and cardiac rehabilitation, which includes structured exercise as well as advice on a heart-healthy diet and management of stress and emotions, which are significant factors in health and healing. To maximize recovery, I strongly recommend ATP-supporting nutrients like coenzyme Q10, carnitine, ribose, and magnesium to strengthen the heart, along with other supplements with proven cardiovascular benefits.
Let’s return to the original question: Should you have heart valve replacement surgery?
For mitral valve problems, you can wait and try alternatives—and you may never need surgery. However, if you are having symptoms of aortic valve disease and your left ventricle starts to get a little bit enlarged, have the surgery and get on with your life. You'll be glad you did.