Aortic Valve Replacement - A Better, Durable Option | Atrium Health

By John R. Frederick, MD, Co-Director, Center for Aortic Disease

For years, it’s been standard practice to perform valve replacement for patients with moderate to severe aortic insufficiency. This approach can help many patients live longer, healthier lives – but it has some drawbacks for patients under 60 who need a long-term fix.

For those patients, valve repair has emerged as a better, more durable option. Repaired valves can last far longer than tissue valves, and patients who undergo valve repairs don’t have to take anticoagulants for the rest of their lives.

The Limits of Aortic Valve Replacement

Here at Sanger Heart & Vascular Institute, we do more aortic valve replacements than almost any other center in the region, so we know its upsides – and its limits.

Aortic valve replacement can be a very effective way to eliminate regurgitation. But valve replacement also has downsides:

• Tissue or bioprosthetic valves degrade relatively quickly in younger patients, and many of these patients will need repeat surgery within a decade.
• Mechanical valves and ensuing lifelong anticoagulation carry a 25 percent risk of causing a major bleeding episode during their lifespan.
• Because mechanical valves can spur coagulation, patients must take anticoagulants to reduce the risk of venous thromboembolism, stroke or transient ischemic attack.

When to Consider Aortic Valve Repair

Valve repair can be a better option for patients under age 60 whose aortic insufficiency is caused by aortic root dilation. Aortic valve repair re-suspends the aortic valve leaflets, fixing the leak. For instance, if a patient’s leaflets don’t match up well, we can shorten or lengthen them so they close more completely.

This can limit leaks and help prevent hypertrophy and heart failure. And unlike artificial valves, the repairs are durable and effective long-term. In fact, 94 percent of patients remain free from moderate to severe aortic insufficiency for 20 years when valve repair is performed correctly.

Valve repair patients are also spared the risk of tissue valve degradation or increased bleeding risk – and the hassle of frequent blood tests and dosage changes that go along with anticoagulants required for mechanical valves.

Aortic Valve Repair Experts

Given these upsides, any patient with aortic insufficiency under age 60 should be evaluated to see if valve repair is a viable option.

At Sanger, our expertise in both aortic valve replacement and repair means we can determine which option is right for your patients. We are one of the Southeast’s busiest valve repair centers and our surgeons were trained at the highest-volume centers by some of the world’s top experts.

Our surgeons are backed by world-class cardiac imagers who generate precise, preoperative images that pinpoint why a valve is leaking. This lets surgeons zero in on the problem and rapidly repair it, minimizing the time the heart is stopped and setting the stage for outstanding outcomes: Sanger’s aortic repair patients have a less than 1 percent risk of mortality, stroke, renal failure or postoperative moderate to severe aortic insufficiency.

For more information, or to make a referral, call 877-999-7484.