Aortic stenosis: Should I have surgery?

I am 70 years old, and I have been diagnosed with severe aortic stenosis. At my last appointment, my cardiologist said because of risks involved in surgery and my lack of symptoms that I can wait to have surgery until I do have symptoms. However, if I wait until I have symptoms, will I already have irreversible heart damage that could have been prevented by having surgery earlier?

- Mike / Kentucky

Answer

This is a controversial issue. Current guidelines published by an expert panel of the American College of Cardiology and the American Heart Association indicate that people with severe aortic stenosis who have symptoms or reduced heart function should have valve replacement surgery whenever possible. However, recommendations for those who don't have symptoms are less clear.

Most of the available evidence indicates that it's reasonable to delay valve replacement surgery in individuals without symptoms. Although, many people develop symptoms within a few years. The outlook is variable. One reason to delay surgery is that artificial valves are prone to complications and structural deterioration — which may require additional surgery to correct.

The decision to delay surgery depends on the specific details of your overall medical condition as well as the condition of your heart. For individuals with severe aortic stenosis who don't undergo valve replacement surgery, it's recommended that an echocardiogram be rechecked within one year — sometimes earlier for high-risk individuals.

Although there is some concern about irreversible heart damage, this hasn't been proved to occur in people with severe aortic stenosis who have normal heart pumping function (ejection fraction). It's important to watch for any signs or symptoms of aortic stenosis, which may be subtle, and report them promptly to your doctor. These include shortness of breath, chest discomfort, and fainting or dizziness.

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