It's Topic Tuesday!
Good morning, Aortic Hope community! As you probably know, September is Aortic Disease Awareness Month, and this week we are covering an important topic: the treatment of aortic valve disease which often goes hand in hand with many of the other aortic conditions we discuss.
A Quick Refresher: What Is Aortic Valve Disease?
Your aortic valve is the "door" between your heart's main pumping chamber and the aorta. Aortic valve disease generally shows up in one of two ways:
Aortic stenosis: The valve becomes stiff or narrowed, making it harder for the door to open
Aortic regurgitation: The three leaflets of the valve do come together nicely to form a tight seal (what we call “copatation”) which allows blood to leak backward
Some patients have a mix of both. The good news is that treatment options today are better than ever, and the right approach depends on your specific situation.
Treatment Starts with Monitoring
Not every patient with aortic valve disease needs a procedure right away. For mild or moderate disease, the best treatment is often careful monitoring.
This usually includes:
Regular echocardiograms to track how the valve is working
Routine check-ins with your cardiologist
Watching for symptoms like shortness of breath, chest discomfort, or fatigue
Many patients live for years in this monitoring phase. The goal is to identify the right time for intervention which is before the heart becomes strained, but not before it is necessary.
The Role of Medications
While no medication can fix a damaged valve, medicines play an important supporting role. They can:
Control blood pressure to reduce stress on the heart and valve
Manage symptoms like fluid buildup
Treat related conditions such as irregular heart rhythms
One of the responsibilities of a cardiologist include adjusting these medications over time as conditions change. Medications are often a bridge that helps keep people stable and feeling their best while the valve is monitored.
When Is It Time for a Procedure?
The care team may recommend fixing the valve when:
The valve disease becomes severe
Symptoms develop
The heart shows signs of strain or reduced function on imaging
Repair vs. Replacement
When a procedure becomes necessary, there are two broad approaches: repairing the exisitng valve (ie the valve you are born with), or replacing it with a prosthesis.
Valve Repair
In some cases, especially with regurgitation where the leaflets are still healthy, surgeons can repair your own valve rather than replace it. Repair preserves the natural tissue and may avoid the need for blood thinners. It is not possible in every case, particularly when the valve is heavily calcified, but it is an excellent option when feasible.
Valve Replacement
When repair is not possible, the valve is replaced. This is where you may hear about two main types of replacement valves:
Mechanical valves: Very durable, but require lifelong blood thinners
Tissue (bioprosthetic) valves: Avoid long-term blood thinners, but may wear out over the course of many years
Surgical vs. Transcatheter Approaches
There is one more important distinction in how a valve can be replaced:
Surgical Aortic Valve Replacement (SAVR)
This is the traditional open-heart approach, where the surgeon removes the diseased valve and sews in a new one. It remains an excellent, time-tested option, particularly for younger patients, those needing other heart procedures at the same time, or those with certain valve anatomy.
Transcatheter Aortic Valve Replacement (TAVR/TAVI)
TAVR is a less invasive approach where a new valve is delivered through a catheter, usually inserted through an artery in the leg (no open-chest surgery required). Originally developed for patients who were too high-risk for surgery, TAVR is now an option for a growing number of patients.
A Special Note for Aortic Disease Patients
For many in our community, valve disease does not exist in isolation. If you also have an aortic aneurysm, especially at the aortic root, your surgeon may address both the valve and the aorta in a single operation (such as a Bentall procedure or a valve-sparing root replacement). This is why it is so important to have a care team experienced in the full spectrum of aortic disease.
The Bottom Line
Treating aortic valve disease is not one-size-fits-all. It ranges from careful monitoring and medications, to repair, to surgical or transcatheter replacement. The best plan depends on your valve, your heart, your anatomy, and your life.
The most important thing you can do is stay engaged: keep your appointments, know your numbers, report new symptoms, and ask questions. With today's treatment options and an experienced care team, the outlook for patients with aortic valve disease is better than ever.
Happy Aortic Disease Awareness Month, and as always, Think Aorta!
Jack
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