Aortic Stenosis: When To Get Surgery or TAVR

Finding out you have a valve condition like aortic stenosis is unsettling. There are probably lots of different questions, concerns and emotions competing for space in your head. More than anything, you’re probably wondering: What happens next?

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The answer can vary from person to person.

Interventional cardiologist Grant Reed, MD, explains the factors that determine when surgery, or transcatheter aortic valve replacement (TAVR), is needed for severe aortic stenosis and how doctors decide which kind of procedure you need.

When to replace your heart valve

There are three main criteria that your cardiac care team uses to decide whether you need surgery or treatment for severe aortic stenosis:

How bad the narrowing is: Providers will use imaging tests to see how narrow your aortic valve is and how badly it’s impacting your blood flow. Dr. Reed says you’re likely to need surgery if your aortic valve area is less than 1 cm² (one square centimeter).
How well your heart’s coping: When your aortic valve is tighter than it’s supposed to be, your heart has to strain to pump blood to the rest of your body. Your provider can figure out how that’s affecting your heart health by checking how much blood your left ventricle pumps out with each heartbeat (your ejection fraction). If you have a normal ejection fraction, your doctor may suggest aortic valve replacement based on other measures, including lab tests, an abnormal stress test and how fast the stenosis is progressing.
How bad your symptoms are: Many people with severe aortic stenosis have noticeable symptoms like shortness of breath, chest pain, fatigue, dizziness, lightheadedness or fainting. These can be signs that your condition is getting worse and that it’s time to think about aortic valve replacement.

One other thing: Some people who need treatment for aortic stenosis don’t have any noticeable symptoms. Dr. Reed reports that most people in this situation will develop symptoms within a year or two. Ideally, you want to correct the problem ahead of time so your heart doesn’t get damaged in the meantime.

“That’s why many people are motivated to get the valve replaced even before they have symptoms — or at the earliest onset of symptoms,” he adds.

Types of treatment for aortic stenosis

There are two ways to replace an aortic valve: surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).

SAVR is an open heart surgery, meaning the surgeon makes either an incision down the middle of your breastbone (sternotomy) or an incision on the side of your chest, in between your ribs (thoracotomy). They then cut the diseased valve out and replace it with a new one.
TAVR is an interventional cardiology procedure. It’s less invasive and has a shorter recovery time. The interventional cardiologist makes a small opening — usually in your groin — and feeds a catheter up through the artery. That catheter then slides a prosthetic replacement valve inside of your old one.

Which approach is best for you depends on several factors, including:

Your age
Your overall health
Whether you may benefit from having other heart procedures (like a bypass surgery) done at the same time

“The decision is very individualized,” Dr. Reed emphasizes. “In all cases, a team of experts reviews your case before making a recommendation.”

Regardless of which procedure you get, he points out that the benefits of aortic valve replacement usually far outweigh the risks.

“There are few treatments that are as effective as aortic valve replacement for restoring both quality of life and life expectancy. They can help you feel better and live longer,” he emphasizes.

Can severe aortic stenosis be reversed without surgery or TAVR?

SAVR and TAVR are the only definitive treatments for aortic stenosis. If you’re not a good candidate for those procedures — or opt not to have them — Dr. Reed says the conversation shifts to medical management and supportive care.

Left untreated, severe aortic stenosis carries a high risk of heart failure and early death.

“We’ll use medications to help manage heart failure symptoms, but there are no other treatments that can correct severe aortic stenosis,” he explains. “Our goal at that point would be to maximize your quality of life for as long as possible.”

The good news? Rapid advancements in cardiac care mean that SAVR and TAVR are becoming options for more people than ever before.

Think beyond the now

Having different treatment options for aortic stenosis is undeniably a good thing. But that doesn’t make the decision-making process any less overwhelming.

Dr. Reed’s advice? Keep your (and your care team’s) focus on the big picture. What’s easiest or most convenient in this moment may not be the best choice for your heart health long term.

“It’s important to ask your care team what your lifetime valve disease management plan looks like,” Dr. Reed stresses. “It’s not just about what your providers can do now, but what approach will reduce your chances of needing open heart surgery later in life.”

This ensures that the treatment decisions you make today support your health for years to come.