Q&A: Valve Replacement Surgery: Do I Need It?

My cardiologist tells me that I have a leaking heart valve. She wants to do a valve replacement. How safe is this?

Surgery is often promoted as the best option for valvular disease. Whether it's right for you largely depends on which type of valve malfunction you have.

I often see patients with mitral regurgitation for whom another doctor has recommended surgery. When the mitral valve leaks, the left atrium of the heart becomes stretched. This can certainly create problems, but it's less critical to overall cardiac function than the effects of aortic regurgitation. Therefore, I tend to be very conservative when it comes to mitral valve surgery, unless quality of life is compromised. For example, I don't believe surgery is best for someone age 80 or older who's tolerated a leaky valve for many years. For those folks—and others with the condition—I usually recommend that they monitor their symptoms carefully and see their doctor if they intensify. You should also have an annual echocardiogram to monitor the status of your leaky valve.

Metabolic cardiology has enormously improved patients who have heart failure or dilated cardiomyopathy as a result of the regurgitation. Metabolic cardiology involves taking CoQ10, magnesium, L-carnitine, and D-ribose daily to support your heart.

It's a different and more troubling situation if the aortic valve begins leaking—especially if the heart has started to become enlarged as a result. This condition, called aortic regurgitation, is an indication for surgery. The heart pumps blood out of the left ventricle through the aortic valve, where it moves into the aorta and on to the rest of the body. Because a leaky valve cannot shut tightly, some of the blood will slosh back into the left ventricle. The ventricle then has to work harder to completely expel the fluid, and it eventually becomes swollen. Once the heart wall stretches and thins, it won't return to its normal size.

The timing of aortic valve replacement is somewhat of a dilemma. I choose to be aggressive. I prefer aortic valve replacement sooner rather than later, when less damage has been done to the heart.