Your heart works tirelessly, beating roughly 100,000 times a day to keep blood moving through your body. At the center of this incredible process is the aortic valve. It acts as the main gatekeeper, controlling the flow of oxygen-rich blood from your heart to the rest of your body.
When the aortic valve works correctly, it opens wide to let blood out and closes tightly to prevent blood from flowing backward. When it fails, your heart faces a mechanical problem that can gradually damage the heart muscle.
If you or a loved one has been diagnosed with aortic valve disease, understanding the condition is a powerful first step toward making good decisions and getting the care you need.
The Two Faces of Aortic Valve Disease
Aortic valve disease generally appears in one of two ways, stenosis or regurgitation.
Think of your aortic valve as a door. For the “room” (your heart) to function, the door must swing open easily. When it doesn’t, we call it aortic stenosis. Then the door has to close tightly. When it doesn’t close well, we call it aortic regurgitation (also called aortic insufficiency). While both disrupt blood flow, they do so differently and place different kinds of stress on the heart muscle. Some patients have a mixed problem, meaning the valve is both difficult to open and leaky.
Aortic Stenosis: The Door Will Not Open Easily
Aortic stenosis is the most common form of valve disease, especially as we age, although some are born with a valve (most commonly called a bicuspid aortic valve) that is often destined to become stenotic.
- In aortic stenosis, the valve leaflets (the flaps that open and close) become stiff, thickened or fused, often from calcium buildup. It is like rust on a hinge, gradually limiting how far and how fast the door can open.
- As the opening becomes narrower, your heart muscle must pump harder to push the blood through the narrowing valve. Over time, the heart muscle thickens and stiffens, affecting its ability to relax and accept oxygen-rich blood returning from the lungs.
Aortic Regurgitation: The Door Will Not Close
Aortic regurgitation, also called insufficiency or incompetence, occurs when the valve leaflets do not seal tightly after blood is pushed out of the heart into the bloodstream, causing blood to leak backward into the heart after each heartbeat.
- With the extra blood volume load, the left part of the heart (the left ventricle) must handle not only the incoming blood from the lungs but also the extra blood that leaks backward, leading to stretching and enlargement of the left ventricle. Over time, the ventricle can weaken, affecting its ability to push blood forward.
- Regurgitation can be caused by problems with the aortic valve leaflets or by enlargement of the aorta (and aortic ring) itself that prevents the leaflets from meeting in the middle. That is why your evaluation often includes careful measurement of your aortic root and ascending aorta.
Why These Conditions Require Treatment
Both aortic stenosis and regurgitation can lead to symptoms like shortness of breath, often first appearing with activity and then potentially even at rest. Other symptoms include chest pressure or pain, lightheadedness, and fainting, which can make activities like driving unsafe.
Aortic valvular heart disease can lead to:
- Heart failure, where the heart becomes either too weak or stiff to pump enough blood to meet the body’s needs;
- Arrhythmias, where the heartbeat becomes fast or irregular and compromises blood flow;
- Limitations in daily activities, where breathing difficulty or fatigue reduces quality of life.
Why a Valve Center Evaluation Matters
Modern valve care is team-based. While medications may be able to help manage symptoms and stabilize conditions associated with blood pressure, fluid retention and heart rhythms, they cannot reverse the valve narrowing or help make a valve not leak. Even when symptoms are mild, timely specialist evaluation matters because waiting too long can reduce the chance for full recovery of heart function once the valve is fixed.
A Valve Center brings cardiologists, imaging specialists, interventional cardiologists and cardiac surgeons together to review the same data and recommend the safest, most durable option for you.
Doctors generally judge severity of your valve disease using an echocardiogram (or ultrasound of the heart) to determine the function of the aortic valve. Your doctor and their team also track your symptoms, blood pressure, heart size and pumping function over time.
Fixing the Problem: Repair, Surgical Replacement and Transcatheter Replacement
When aortic valve disease becomes severe, or if symptoms begin to interfere with your life, the goal is straightforward. Restore forward flow by modifying or replacing the damaged aortic valve to protect the heart muscle before damage becomes irreversible.
Today, the key options include:
- surgical aortic valve repair (SAVR),
- surgical aortic valve replacement (including the Ross procedure), and
- transcatheter aortic valve replacement (TAVR).
The best choice often depends on the anatomy of your valve, your age, other medical conditions, how long the different types of valves last, and, most importantly, your goals and preferences.
Surgical Aortic Valve Repair
Repair aims to preserve your natural living valve tissue. Repair is advantageous because it preserves your own living tissue, which fights infection better than artificial materials and often avoids long-term blood thinners. However, repair is not always possible, especially if the valve is heavily calcified (stenosis). It is most often used for regurgitation when leaflet tissue is still healthy, but the structure is loose.
Common repair techniques include:
- Tightening the valve ring to improve leaflet closure
- Repairing tears or small holes in the leaflets.
- Reshaping valve tissue so the leaflets meet properly
Surgical Aortic Valve Replacement (SAVR)
For patients with severe stenosis or valves that are too damaged to repair, replacement is highly effective.
Two main types of replacement valves are used:
- Mechanical valves, which are very durable (made of carbon and metal) but require lifelong blood-thinning medication (warfarin) with regular blood test monitoring to prevent clots.
- Biological tissue valves, made from bovine or porcine tissue, typically last about 10 to 20 years (often longer in older adults and shorter in younger patients) and many patients do not require long-term warfarin.
The Ross Procedure is another surgical option that replaces the patient’s aortic valve with their own pulmonary valve. This option is often considered for younger patients (typically under 55 years old) and can provide excellent long-term results without the need for lifelong blood thinners. Because it is more complex, it is best discussed in centers with dedicated experience and careful patient selection.
Transcatheter Aortic Valve Replacement (TAVR)
TAVR is a catheter-based procedure, A new valve is delivered through a catheter, most often passed through an artery in the leg, and expanded inside the old valve. In many patients, TAVR allows faster recovery with a shorter hospital stay, while still providing excellent symptom relief and survival benefit in the right patient with the right valve anatomy.
Recovery and the Road Ahead
Feeling nervous about heart surgery is completely normal. Aortic valve interventions are among the most common and successful cardiac procedures performed today. The typical recovery pattern includes a hospital stay of several days after open heart surgery while many TAVR patients go home in one to two days, though some need longer monitoring based on heart rhythm, kidney function or bleed at the catheter site.
At home, early fatigue is common while walking is encouraged and heavy lifting is restricted. This is usually followed by a supervised cardiac rehabilitation program to help rebuild strength and confidence safely.
Most patients report feeling significantly better after recovery than they did before the valve was treated. Shortness of breath, fatigue and chest pressure often improve dramatically once the valve is functioning properly.
The Importance of Early Evaluation and the Stony Brook Valve Center
Heart valve disease is progressive. A mild leak or slight narrowing today can become a severe, life-threatening issue over time. The most dangerous course of action is ignoring symptoms.
At the Valve Center at Stony Brook Heart Institute, patients are typically seen within one week of referral, and testing plus specialist consultations are coordinated into a single efficient visit whenever possible. We combine advanced imaging, individualized valve selection and approach, and a Heart Team approach to deliver a clear plan and the safest treatment pathway. Because we participate in clinical trials, eligible patients may have access to emerging valve technologies and next generation management tools. For more information, visit our website or call (631) 444-3278.
