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Treatments

Monitoring Your Condition


Mild Aortic Stenosis

  • If you have mild aortic stenosis, your condition will be monitored, but may not need immediate treatment.
  • If your condition is more severe, your doctor may advise you to avoid strenous physical activity.

Medical Therapy

If necessary, your physician may prescribe medications.

  • These could include cholesterol-lowering drugs, such as statins, which slow the progress of stenosis in some patients.
  • Your doctor may also prescribe medications to control heart rhythm disturbances associated with aortic valve stenosis.

As the disease progresses, however, valve replacement surgery becomes necessary.

Balloon Valvuloplasty


Less Invasive Approach

Most patients with aortic stenosis need valve replacement surgery, but in rare cases balloon valvuloplasty, a less invasive approach, may be appropriate.

  • Balloon valvuloplasties are performed by interventional cardiologists.
  • The doctor guides a flexible catheter (a thin tube) with a balloon at its tip through a small incision in the groin or arm and into the heart.
  • The balloon opens inside the valve, forcing it to enlarge and improving blood flow.
  • The catheter is then removed.
  • Balloon valvuloplasty is often as successful as surgery depending on the structure of the mitral valve.

Surgery


Severe Aortic Valve Damage

In most cases where aortic valve damage is severe, valve replacement is the standard of care. In rare cases, the valve can be repaired.

Traditional Aortic Valve Replacement Surgery


  • During traditional aortic valve replacement surgery, your surgeon makes a six-to-eight-inch incision through the center of your breastbone, dividing it to allow access to your heart. In some cases, a partial sternotomy can be performed instead. This is a less invasive method of getting to the sternum, requiring a three-inch incision instead.
  • Once your sternum is divided and your pericardium -- the membrane that surrounds your heart -- has been opened, you are placed on a heart-lung machine (bypass). It takes over the task of breathing and pumping your blood while your surgeon replaces your heart valve.
  • Once you are on bypass, an incision is made in your aorta. Your surgeon then removes the diseased aortic valve and puts the replacement valve in its place.
  • Once the valve is in place and your aorta has been closed, you are taken off the heart-lung machine.
  • When the surgery is done, you will stay in intensive care for one to two days and remain in the hospital for a total of four to five days.

Types of Replacement Valves

Your damaged aortic valve can be replaced with either a valve taken or fashioned from a cow or pig's heart or with a mechanical valve made of carbon.

  • Bioprosthetic Valves
    • Aortic Valve Replacement—Mechanical (St. Jude) and Bioprostheses (Porcine) Valve ShownMade of porcine (pig) or bovine (calf) tissue.
    • Do not typically require blood thinners and have an average durability of 10-15 years.
  • Mechanical Valve
    • Made of carbon.
    • Last much longer than bioprosthetic valves.
    • Patients with them must take a blood thinner (Coumadin) for life due to an increased risk of blood clot formation.

You should talk with your surgeon about the pros and cons of both options.

Percutaneous Valve Replacement


Valve Replacement Without Open Heart Surgery

For patients who are not candidates for surgery or in whom surgery carries an extraordinarily high risk, a new technique of valve replacement without open heart surgery is being investigated. This percutaneous (meaning through the skin without open surgery) option is not yet approved for routine use by the Food and Drug Administration.

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-8800

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