Does aortic stenosis need treatment if it has no symptoms? How to treat it surgically?

Author: Wang Huaibin, Chief Physician, Beijing Hospital

Reviewer: Zhang Haicheng, Chief Physician, Peking University People's Hospital

The aortic valve is located at the outlet of the left ventricle and is connected to the aorta. Its function is similar to a one-way valve. When the heart contracts, the aortic valve opens to allow blood to pass through and flow into the aorta, thereby supplying blood to the whole body.

When an ultrasound report shows aortic stenosis, it means that the valve is restricted from opening, leaving only a small gap, resulting in obstruction of the passage of blood from the left ventricle to the aorta. This forces the heart to exert greater force to pump blood, thus increasing the heart's workload.

Figure 1 Original copyright image, no permission to reprint

1. Does aortic valve stenosis need treatment if it has no symptoms?

If the ultrasound examination report shows mild aortic valve stenosis and no symptoms and normal heart function, there is no need to worry too much.

If the report shows moderate stenosis, but normal heart function and no symptoms, no further treatment is needed for the time being, and regular check-ups are sufficient.

When the report shows severe aortic valve stenosis, even if there are no obvious symptoms, the heart burden will increase significantly, which may cause risks such as fainting, chest tightness, and difficulty breathing, accompanied by a decrease in heart function, and there is a possibility of sudden dangerous events.

For severe aortic valve stenosis, regardless of whether there are symptoms or not, since the damage caused to the heart by valve disease is persistent, you should seek medical attention promptly and have a doctor evaluate whether immediate treatment is needed.

2. What are the surgical treatments for aortic valve stenosis?

Surgical methods include aortic valve repair and aortic valve replacement. The aortic valve is like a one-way valve. If its structure is not severely damaged and can maintain normal opening and closing functions, the original valve will be repaired. This is based on the principle of retaining autologous tissue.

If the evaluation finds that the valve is difficult to repair, or the repair effect cannot maintain normal opening and closing function for a long time, especially if the valve damage is caused by infectious diseases such as infective endocarditis, valve replacement is required, using an artificial valve to replace the diseased valve.

Artificial valves are divided into two types: biological valves and mechanical valves. The diseased valve is removed and a new biological valve or mechanical valve is installed to restore the normal function of the valve and reduce further damage to the heart.

Figure 2 Original copyright image, no permission to reprint

Aortic valve repair or replacement surgery is very mature. Before surgery, the patient needs to be fully evaluated, including overall health status, comorbidities, cardiac function and the functional status of other organs besides the heart, as well as peripheral vascular conditions, to ensure the safety of the surgery.

During the operation, the aortic wall is cut open and the final decision on whether to repair or replace the aortic valve is made based on the actual condition of the disease. Simple aortic valve replacement surgery is usually completed within 3 hours. The time for valve repair varies depending on the severity of the disease, aiming to ensure that the repaired valve has good and lasting opening and closing functions.

It is usually recommended to return to the hospital for a follow-up examination 3 months after surgery, with a focus on echocardiography to assess the stability and opening and closing function of the artificial valve, as well as the size, systolic and diastolic function of the heart. If the overall condition is good, it is recommended to have a follow-up examination once a year thereafter.

3. Are the effects of aortic valve repair or replacement permanent?

For valve repair, the doctor will decide to perform repair surgery after evaluation and confirmation that the repair effect is ideal and the normal opening and closing function of the valve can be maintained for a long time.

As for valve replacement, mechanical valves have been verified by in vitro fatigue tests and can usually be used for thirty to forty years, basically achieving lifelong use. However, after replacing a mechanical valve, anticoagulant drugs need to be taken for a long time to prevent thrombosis.

Biological valves are made of biomaterials that have been de-antigenized and have a certain service life, usually about ten years in normal use, and some can even reach fifteen years. Over time, biological valves may decay and have opening and closing dysfunctions, at which time a second operation may be performed. Currently, some can also be treated again through transcatheter aortic valve implantation.