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It's Topic Tuesday!

Writer: Jack Nickles
Jack Nickles
2h
2 min read

Aortic Valve Repair vs. Replacement


Good morning, Aortic Hope community! This month we’re exploring the most common aortic surgeries, moving down the aorta one week at a time. We’re starting where blood first leaves the heart: the aortic valve.




What the Aortic Valve Does

Your aortic valve is the “door” between your heart’s main pumping chamber and the aorta. Its three thin flaps, called leaflets, open to let blood out and close tightly so it can’t flow back. Valve surgery is usually needed for one of two problems:

  • Stenosis: the leaflets become stiff and narrowed, so the door can’t open fully.

  • Regurgitation: the leaflets don’t close tightly, so blood leaks backward.


Option 1: Repairing Your Own Valve

In a valve repair, the surgeon fixes the valve you were born with instead of replacing it. This might mean tightening a floppy leaflet, reinforcing the ring the valve sits in, or reshaping the root around it.


Repair works best for leaky valves whose leaflets are still flexible, including many bicuspid valves (valves with two leaflets instead of three). It’s rarely possible for stenosis, because the leaflets are usually too stiff and calcified to restore.


The biggest advantage is that you keep your own tissue, and most people don’t need a lifelong blood thinner. The tradeoff is that some repairs start leaking again over time, and repair is a specialized skill, so the surgeon’s experience matters.


Option 2: Replacing the Valve (SAVR)

When repair isn’t possible, the surgeon removes the diseased valve and sews in a new one. This is called surgical aortic valve replacement, or SAVR. You’ll usually choose between:


  • Mechanical valves: built to last a lifetime, but they require a blood thinner (warfarin) and regular blood tests for life.

  • Tissue valves: usually no lifelong blood thinner, but they can wear out after many years. Many people can then get a less invasive valve-in-valve TAVR instead of a second open surgery.


For more detail, see Ani’s post on SAVR and Samantha’s post on mechanical vs. tissue valves.




Recovery and Life After

Both operations are open-heart surgeries, so most people spend about a week in the hospital and recover over 6 to 8 weeks. Afterward, you’ll have regular echocardiograms (ultrasounds of the heart) to check on your valve. Be sure to tell your dentist about your surgery, since you may need antibiotics before certain dental work.


Questions to Ask Your Surgeon

  • Is my valve a good candidate for repair, and how many repairs does your team do each year?

  • If repair isn’t possible once surgery begins, which replacement valve will you use?

  • Will I need a blood thinner afterward, and for how long?


Aortic Hope’s Patient Surgical Plan is a great place to keep track of the answers.


Next Monday, Zach compares two ways to replace the aortic root: the Bentall and the David procedure.


Think Aorta! --Jack

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