Aortic valve repair / replacement (AVR) | Dr Samson Olori

What is aortic valve disease?

The aortic valve controls blood flow from the left ventricle into the aorta and thus to the body. When it is narrowed (aortic stenosis), the heart must work harder to pump blood; when it is leaky (aortic regurgitation), blood flows back into the ventricle. Causes include wear and tear with age (calcification), a congenital bicuspid valve (two leaflets instead of three), rheumatic heart disease, and infection. Symptoms may include chest pain, breathlessness, fainting, and fatigue. Severe aortic stenosis can cause sudden death; severe disease of either type can lead to heart failure. There are no medicines that fix the valve; when the disease is severe, surgery or a catheter-based procedure is needed.

Treatment options

Open-heart surgery to replace the valve is the standard treatment. The damaged valve is removed and replaced with a mechanical or biological prosthesis. Transcatheter aortic valve implantation (TAVI) is an alternative for some patients: a replacement valve is delivered via a catheter (usually through the groin) and expanded inside the old valve, without open surgery. TAVI is often used in older or higher-risk patients. Other options in selected cases include balloon valvuloplasty (to widen a stenotic valve, often as a temporary measure) or sutureless valve replacement. Recovery from open surgery usually involves about a week in hospital and several weeks to months at home. Risks include infection, bleeding, stroke, arrhythmias, and kidney or valve-related problems. We can refer you to a cardiac surgeon or TAVI team to discuss the best option for you.

Diagnosis and recovery

Aortic valve disease is diagnosed by symptoms, examination (heart murmur), echocardiography, and sometimes stress tests or cardiac catheterisation. Your cardiologist will assess severity; severe aortic stenosis or regurgitation often needs intervention to prevent heart failure or sudden death. After surgery or TAVI, you will be monitored in hospital and usually go home within about a week. You will need wound care, a period of restricted activity, and any prescribed medicines (including blood thinners for mechanical valves). Follow-up scans check the new valve and heart function. With successful treatment, symptoms typically improve and long-term outlook is good. We can refer you to a cardiac surgeon or TAVI team and arrange follow-up.

Frequently asked questions

What is TAVI?
TAVI (transcatheter aortic valve implantation) is a way to replace the aortic valve using a catheter, without open-heart surgery. It is often used for older or higher-risk patients. Not everyone is a candidate; your team will advise.
Mechanical vs biological valve?
Mechanical valves last a long time but require lifelong blood thinners to prevent clots. Biological valves (from animal or human tissue) usually do not require blood thinners but may need to be replaced after 10–20 years. Your surgeon will help you choose based on your age and preferences.
What are the risks of aortic valve replacement?
Risks include infection, bleeding, stroke, arrhythmias, and kidney problems. The risk of death from the operation is typically around 1–3%, but the risk of leaving severe valve disease untreated is higher. Your team will explain the balance for you.
When should aortic valve disease be treated?
Severe aortic stenosis or regurgitation usually needs surgery or TAVI, especially if you have symptoms (chest pain, breathlessness, fainting) or if tests show the heart is struggling. Delaying treatment can be dangerous; your cardiologist will advise on timing.