Harvard Heart Letter

Ask the doctor: Should I wait to have my aortic valve replaced?

Ask the doctor

Should I wait to have my aortic valve replaced?

Q. I am an 85-year-old man with advanced aortic valve stenosis, coronary artery disease, and atrial fibrillation. Otherwise, my general health is pretty good. My doctor said I should wait until I experience symptoms or signs of heart failure before having my aortic valve replaced. Shouldn't I get it done before my heart gets so stressed that I go into heart failure?

A. You are getting good advice from your doctor.

I am guessing from your description that your aortic stenosis is not that severe, since people with severe aortic valve narrowing tend to feel quite poorly, especially when they go into atrial fibrillation. Aortic stenosis usually worsens slowly, and generally doesn't cause problems for many years. But once it does cause symptoms such as chest pain, shortness of breath, or fainting spells, it is important to have the valve replaced promptly. Among people your age, about five in 100 experience major complications from having an aortic valve replaced, so if you were my patient I wouldn't recommend you have the operation until you really needed it.

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