What Comes Next: Aortic Stenosis
Making Sense of Your Diagnosis
Reviewed by Columbia Structural Heart and Valve Center Faculty, June 2025
If you’ve just received a diagnosis of heart disease, it can feel overwhelming and confusing. It may be hard to know what to focus on. Having some help with sorting out your concerns and questions can help.
Our What Comes Next series is meant to provide that help by answering common questions that our doctors are asked by patients who have been in the same situation.
I’ve Been Diagnosed With Aortic Stenosis. How Serious Is My Condition?
It can be serious if the stenosis is severe, and especially if you’re experiencing symptoms like shortness of breath, chest pain, or feeling faint. Aortic stenosis (AS) is a type of heart valve disease that affects the aortic valve, which passes blood from the heart to the body's main artery, the aorta. Aortic valve stenosis means that the valve is narrowed and doesn't fully open. Because less blood can pass through the valve’s smaller opening, the heart has to work harder to pass enough blood to the aorta to supply the rest of the body. Severe AS, meaning that the valve’s opening has become too small for enough blood to pass through, is life-threatening.
Will I Need My Valve Replaced?
Yes, you will eventually need your valve replaced, especially with severe AS. (In some cases, the aortic valve can be repaired.) If your AS is not severe, your cardiologist may suggest managing your condition through regular monitoring, lifestyle changes, and medications. But for severe AS, you will likely need your valve replaced. Without a replacement valve, severe AS can lead to heart failure and death.
I Feel Fine. Does That Mean My AS Isn’t Bad?
Not necessarily. Some people develop AS without showing any symptoms until the disease has progressed significantly. At that point, AS symptoms can suddenly appear. If you’ve been diagnosed with AS, your cardiologist must carefully monitor your condition, even if you aren’t experiencing any symptoms.
Can I Avoid Surgery?
Yes, there are non-surgical alternatives for valve replacement. Transcatheter Aortic Valve Replacement, or TAVR, is a non-surgical procedure performed through a small tube inserted in a blood vessel in the leg. The replacement valve and instruments are guided through the blood vessel using advanced imaging. Once the valve is in place, it is implanted into the diseased valve and takes over its function.
Unlike open-heart valve replacement, TAVR is usually performed with local anesthesia and sedation. This means fewer complications, no chest scarring, and a faster recovery. It also means much shorter hospital stays; patients typically go home the next day.
How Long Will A Replacement Valve Last?
Currently, TAVR valves typically last between 8-10 years. Surgical valves can last up to 15-20 years, so they may be a better option, depending on your age.
TAVR valves are relatively new and are being constantly improved upon, so we’re still learning about how long they can last. TAVR was initially used as an alternative for patients who were not candidates for surgery. As TAVR becomes more widely used in younger patients, the focus is shifting toward longevity.
What Happens If My TAVR Replacement Valve Fails?
You may be able to have another valve implanted., including a valve-in-valve procedure, where a new TAVR valve is seated in the previous TAVR valve. In cases in which a second TAVR placement is not possible, surgery to remove the valve is possible.
What Are My Risks?
Like surgery, transcatheter procedures have risks, but for most patients, the risk is lower than surgery. The most common risks include:
- Arrhythmia (irregular heart rhythm) requiring a pacemaker – 6-8%
- Stroke <1%
- Bleeding - <2%
- Infection <1%
- Valve malfunction <1%
Can My AS Return If I Get My Valve Replaced?
With surgery or TAVR, the AS won’t come back once the valve is replaced, but the new valve can eventually wear out.
Will Replacing My Valve Cure Me?
Not entirely. Valve replacement will address the reduced blood flow and should reduce or eliminate your symptoms. It won’t reverse any damage AS has caused to your heart, but it can stop or slow down any additional damage. However, most patients recover to a quality of life close to a level of when they did not have valve disease.
Will I Need Other Valves Replaced?
Possibly. AS is often accompanied by other valve diseases, such as mitral valve disease. Your cardiologist will monitor for signs of problems in your mitral or tricuspid valves.
How Much Can I Expect My Symptoms To Improve?
A lot. Most patients feel a noticeable reduction in symptoms soon after the procedure. In many cases, AS symptoms can be eliminated entirely.
Will Replacing My Valve Make Me Live Longer?
Yes. If left untreated, severe AS has been shown to significantly shorten lifespan. Valve replacement greatly increases survival while improving quality of life.
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