Depending on the severity of your aortic regurgitation, your cardiologist may recommend:
- Surgical treatments
- Non-surgical, less invasive treatments
To learn about the various treatment options for aortic regurgitation, keep reading.
Medications for Aortic Regurgitation
No medications have been proven to help the flaps of the aortic valve close properly. However, your doctor may recommend medications to help reduce the symptoms of aortic regurgitation.
If you are diagnosed with mild (grade 1) or moderate (grade 2) aortic regurgitation, your doctor may decide the best approach is to continue monitoring your condition and prescribe drugs to help treat its symptoms. These medications may include --
- Diuretics: These medications help reduce fluid accumulation in your body by increasing fluid loss through urination.
- Anti-hypertensive medications, which decrease high blood pressure, a condition that can complicate aortic regurgitation. One or more of these medications may be prescribed to help manage your blood pressure:
- Beta blockers. These medications reduce heart rate and the heart’s output of blood.
- Vasodilators, which widen (dilate) blood vessels. Examples include ACE inhibitors and calcium channel blockers.
- Antibiotics or drugs that kill bacteria may help prevent or treat an infection of the heart valves (endocarditis). Leaking heart valves are at a higher risk of being infected during routine teeth cleaning or other surgeries.
Even if you are on medications, you may notice an increase in fatigue or shortness of breath. If this occurs, you should let your doctor know immediately.
To learn more about medications that doctors prescribe for heart valve problems, click here.
Surgical Treatments for Aortic Regurgitation
If you are diagnosed with moderate to severe (grade 3) or severe (grade 4) aortic regurgitation, your doctor may recommend a surgical treatment.
One measure used to determine whether a surgical approach should be taken is called ejection fraction. The ejection fraction measures the fraction of blood your heart’s left lower chamber (left ventricle) is able to pump out to the body during a heartbeat.
Surgery is recommended to treat the aortic valve if the ejection fraction drops below 60 percent, or if the left ventricle is enlarged (larger than 50 millimeters). Your doctor may recommend surgical treatment of the valve if these changes in your left ventricle are detected by ultrasound, even if you do not have symptoms. Depending on your condition, your doctor may recommend:
- Valve repair
- Valve replacement
Whenever possible, valve repair is preferred over valve replacement.
What to Expect During Valve Surgery
Before surgery, you will receive a general anesthetic, which is a medicine that will put you into a deep sleep during the procedure. Your doctor will make a cut (incision) along the length of the flat bone in the center of your chest (breastbone) to expose your heart. You will be connected to a heart-lung machine, which will take over your breathing and blood circulation during the surgery. The surgeon will stop your heart, make a cut in it to expose the valve, then repair or replace the valve.
Aortic Valve Repair
Various techniques may be used, either alone or in combination, to repair the aortic valve:
- Leaflet reconstruction: The surgeon will “remodel” the valve by removing or adding to the leaflet tissue that is present.
- Aorta reconstruction: The surgeon may replace or remodel part of the aorta if it is enlarged and re-suspend the aortic valve leaflets within the new aorta.
Aortic Valve Replacement
If your valve cannot be repaired and it must be replaced, your surgeon will implant an artificial (prosthetic) valve. An artificial valve can be mechanical or tissue.
Mechanical valves are devices made of metallic materials, such as titanium. They offer life-long durability. The main risk with mechanical valves is blood clot formation (thromboembolism). In order to prevent blood clots, you will need to take blood-thinning medications for the rest of your life after receiving a mechanical valve.
A secondary risk is associated with taking the blood-thinning medications. These medications increase the risk of bleeding. If the blood-thinning drugs make the blood too “thin,” then you can experience excessive bleeding, even with minor cuts. If the blood is too “thick,” clots can form on the valve. If a clot later breaks off, it may lodge in the blood vessels to the heart or brain and cause a heart attack or stroke.
Tissue valves are made of valve tissue taken from a cow (bovine), pig (porcine) or human cadaver (homograft). Because tissue valves do not encourage blood clot formation, patients who receive tissue valves do not need to take blood-thinning medicines. However, tissue valves have not historically been as long-lasting as mechanical valves. A tissue valve (also called a bioprosthetic) can wear out over a period of 10 to 15 or more years. If it deteriorates significantly, it must be replaced. Replacement, of course, requires repeat surgery, with its associated risks. Because of durability concerns, tissue valves are implanted primarily in older patients. However, newer tissues valves have improved steadily and are being used more and more frequently.
Risks of Aortic Valve Surgery
As with any medical procedure or surgery, there are risks associated with heart valve surgery. As always, it is important to talk with your care team about your treatment options and the benefits and risks that are associated with each option. The main risks associated with heart valve surgery include --
- Death. The overall mortality risk (risk of death) for heart valve surgery is about 5 percent. (In other words, 5 out of every 100 patients will die.)
- Irregular heartbeat (arrhythmia). Arrhythmias can make you tired or short of breath and put you at risk of blood clots. You may need to take blood-thinning (anticoagulant) medications to lower the risk of blood clots.
- Infection. After valve surgery, you may be prone to an infection or inflammation of the heart valves (endocarditis). It occurs when bacteria enter the bloodstream and infect damaged valve leaflets. People who have abnormal or damaged heart valves or who have received an artificial heart valve are more vulnerable to the infection.
- Risks associated with being put to sleep with general anesthesia.
- Risks associated with surgery, including bleeding.
Recovery After Aortic Valve Surgery
After valve surgery, recovery in the hospital may last from 4 to 10 days, depending on your condition. You may spend the first days after surgery in an intensive care unit (ICU), where your heart will be closely monitored.
While in the ICU, you may have a number of tubes in your body to help recovery, including a tube to help you breathe, to drain fluids from the stomach while you are not eating, to drain fluid from your chest, to empty your bladder and to measure blood pressure. These will be removed when you are moved out of the ICU to another care unit.
You will receive therapy to prevent complications such as pneumonia, collapsed lung or infection. A nurse or therapist may lead you in deep breathing exercises and coughing and encourage you to move your legs to lower the chance of blood clot formation. Your therapy may also include gentle patting on the back to loosen fluids in the lungs.
Physical therapy will also be part of the recovery process. In the hospital, you will be encouraged to walk around and will be shown how to move your arms without hurting your breastbone. You will also learn how to do daily activities in ways that will not interfere with the healing process.
Careful monitoring to ensure the correct levels of anti-coagulation medications is critical. It may require a monthly visit to the doctor's office. New home monitoring units may make it possible to regulate your blood levels without going to the doctor's office.
Non-Surgical, Less Invasive Treatments
Depending on your condition, your doctor may be able to recommend a less invasive, non-surgical treatment for your aortic regurgitation. This treatment, called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI), uses a small, flexible tube (catheter) that is inserted from a small hole in the blood vessel in your leg and guided through the arteries to your heart. To learn more about how TAVR (or TAVI) works and which patients it is appropriate for, click here.
If you have heart valve disease, it is important to understand your condition so that you can work closely with your healthcare team to develop a long-term plan for your care. We invite you to check out the SecondsCount Valvular Heart Disease Center here. In this center, you’ll find information on additional resources to turn to, as well as tools to help you track your medications.