There is no medical therapy for aortic stenosis. When a patient's heart problem is caused by a physical obstruction to blood flowing out of the heart, the only effective treatment is to relieve the physical obstruction. This means surgery. While various drugs used for heart failure (digitalis and diuretics for instance) can ameliorate symptoms for a short time, these drugs do not halt the progression of the disease, nor do they significantly delay the patient¡¯s demise.

So with aortic stenosis, the question is not whether to do surgery, but when.

Surgical therapy.

The treatment of aortic stenosis consists of replacing the native valve. Operative mortality for aortic valve replacement is approximately 3-5%. The risk, obviously, is higher in elderly patients or those with additional medical problems.

Approximately 85% of patients having aortic valve replacement will live for at least 5 years after surgery.
The timing of valve replacement surgery

As a general rule, because valve replacement surgery is such a large procedure, valve replacement surgery should be withheld until the heart¡¯s compensatory mechanisms begin to fail.

As long as the ventricle can compensate for the obstruction to blood flow, the patient's native valve should be left in place. But as soon as the patient's ventricle begins to fail, and certainly at the first sign of symptoms, valve replacement should be planned.

For this reason, patients with known aortic stenosis should be followed by a cardiologist, with periodic echocardiograms to evaluate the status of the valve opening and the function of the left ventricle.

The good news about surgery for aortic stenosis is that, because severe obstruction to the outflow of blood from the heart is being suddenly relieved, in most cases the function of the heart improves dramatically and immediately. Once the patient recovers from the operative procedure, they almost always feel much, much better than they did prior to surgery.