Why should I wait to have aortic valve replacement if I am a senior?

People with severe aortic valve narrowing tend to feel quite poorly, especially when they go into atrial fibrillation. Aortic stenosis usually worsens slowly, and generally doesn't cause problems for many years. But once it does cause symptoms such as chest pain, shortness of breath, or fainting spells, it is important to have the valve replaced promptly.

Among older people, about five in 100 experience major complications from having an aortic valve replaced, so if you were my patient I wouldn't recommend you have the operation until you really needed it. Another reason to wait, if you can, is that for every year that goes by, the possibility that some less traumatic way of replacing the aortic valve, as compared with open-heart surgery, becomes more of a reality. Some surgeons now replace aortic valves using a smaller-than-usual incision, which can speed recovery.

Researchers are also testing ways to fix a failing aortic valve with a procedure similar to balloon angioplasty, but this approach isn't yet ready for prime time.

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