Timing of aortic valve replacement surgery

Researchers are looking for ways to predict the progression of aortic valve stenosis based on the results of diagnostic tests. The goal is to find a way to use diagnostic tests, such as echocardiograms, to predict when aortic stenosis will become severe enough to require surgery. Unfortunately, there currently is no widely accepted method for predicting the progression of aortic stenosis. Without a reliable method of prediction, the only alternative is to wait for symptoms to appear.

Is early surgery ever beneficial?

Although the "wait for symptoms" rule still applies to the majority of people who have aortic stenosis, evidence from several clinical studies suggests that there may be exceptions. Some experts believe that some people who have aortic stenosis may in fact benefit from having valve replacement surgery before they experience symptoms, particularly people who are at risk for sudden death. While sudden death is rare before symptoms appear, it has occurred.

Most doctors still advise waiting for symptoms because there currently is no accepted method for determining who would benefit from early surgery.

Should valve replacement surgery be added to planned coronary bypass surgery?

Another area of controversy surrounds whether to replace the aortic valve before symptoms appear if you need to have coronary artery bypass grafting (CABG) to treat coronary artery disease (CAD). Because coronary bypass surgery is also generally performed as an open-heart procedure, most doctors believe that people who have severe aortic stenosis should get their valve replaced at the same time. Some experts have even suggested that people who have moderate aortic stenosis should consider valve replacement at the time of CABG surgery.