Aortic valve replacement: What to do when the aortic valve fails?
If the aortic valve is so leaky or narrowed that you suffer from symptoms, it may be necessary to replace the defective valve. There are various options to help you feel better again soon - catheter-based aortic valve implantation (TAVI) and valve replacement surgery.
A defective aortic valve can cause various symptoms, depending on whether it is leaking or whether it is calcified and narrowed; in the former case, doctors speak of aortic valve insufficiency, in the latter of aortic valve stenosis. The symptoms of aortic valve insufficiency include, for example, reduced resilience, rapid fatigue and shortness of breath. Chest pain can also occur: As the coronary arteries no longer have sufficient "pressure on the line", they can no longer supply the heart with enough oxygen. Aortic valve stenosis usually manifests itself in symptoms similar to those of aortic valve insufficiency, but dizziness and brief fainting spells are also possible, especially during or after physical exertion.
Signals that may indicate a disease of the aortic valve:
- Do you often feel tired and less energetic than before?
- Do you find it difficult to climb stairs or go shopping?
- Are you out of breath more quickly or do you feel exhausted more quickly than before?
- Do you often feel dizzy, especially after exerting yourself physically?
The doctors treating you will examine your heart carefully to find the cause of your symptoms. If the aortic valve needs to be replaced, this can be done in two ways:
- surgically, i.e. in a heart operation in which the new valve is inserted through an incision in the chest
- minimally invasive using a catheter; doctors refer to this procedure as transcatheter aortic valve implantation (TAVI)
What is the function of the aortic valve?
The aortic valve regulates the flow of blood from the heart into the aorta: when the heart contracts, it pushes the blood from the left ventricle through the aortic valve into the systemic circulation. When the ventricle then relaxes again and fills with new blood, the aortic valve prevents blood from flowing from the aorta back into the heart - similar to a tire valve, which ensures that air only gets into the tire and not out again.
| TAVI | Aortic valve replacement surgery | |
| The heart | continues to beat independently, therefore no heart-lung machine is necessary | must be temporarily stopped, a heart-lung machine takes over the function |
| Access | usually via a small incision in the groin | via an incision through the sternum or between the ribs |
| Type of artificial heart valve | Biological aortic valve only | mechanical or biological aortic valve |
| Anesthesia | Light anesthesia or local anesthesia, rarely general anesthesia | General anesthesia |
| Duration of the procedure | Usually less than 1 hour | usually 2 to 3 hours |
| Length of hospital stay | less than 5 to 7 days | usually about 2 weeks |
TAVI and surgery in comparison
Various factors play a role in the decision between TAVI and surgical aortic valve replacement. These include the surgical risk, the general state of health, the individual anatomical conditions of the heart and vessels and whether an operation is planned anyway, for example bypass surgery. The equipment and experience of the respective hospital with these two procedures also plays a role in whether the doctors opt for a TAVI or a conventional, surgical aortic valve replacement. All these factors must be carefully weighed up for each individual case. Therefore, an experienced heart team of cardiologists, cardiac surgeons and anesthetists will work with you to decide on the appropriate method after carefully explaining the benefits and risks.
- References
- www.bhf.org.uk/informationsupport/treatments/tavi
- www.nice.org.uk/guidance/ipg805/chapter/2-The-condition-current-treatments-and-procedure
- www.nhs.uk/tests-and-treatments/aortic-valve-replacement/whyitsdone/
- www.nice.org.uk/guidance/ng208/chapter/Recommendations
- www.england.nhs.uk/publication/tavi-and-savr-position-statement/
9-UK-5-16515-01 08-2025