Blood returning from the body reaches the right side of the heart and is pumped to the lungs for oxygen. It returns to the left atrium, passes through the mitral valve into the left ventricle, then leaves through the aortic valve into the aorta. The aorta carries blood to the body; coronary arteries branch from it to supply the heart muscle itself.

Valve leaflets open as blood is pushed forward and close to limit backward flow. The aortic valve sits at the outlet of the left ventricle. It normally has three leaflets, although some people are born with two, called a bicuspid valve. Aortic valve replacement changes that outlet; it is different from bypass or angioplasty, which address coronary artery narrowing.

Aortic stenosis means the valve does not open fully, restricting blood flow out of the left ventricle. The heart has to pump against that narrowing. Aortic regurgitation means the valve does not close properly and some blood leaks back into the ventricle. Both can occur together, and the pattern of strain and the treatment decision depend on the type and severity.

Valve disease can be associated with ageing, a bicuspid valve, previous rheumatic fever or infection of the heart lining, called endocarditis. Some people notice breathlessness, chest discomfort, dizziness, fatigue, palpitations or swollen ankles; others have no symptoms. Symptoms have other possible causes, and the absence of symptoms does not always mean the valve or heart is unaffected.

An echocardiogram uses ultrasound to show the heart and valves. It helps assess valve opening or leakage and the size and pumping function of the left ventricle. A clinician also asks about symptoms and listens for a murmur. Depending on the question, an ECG, blood tests, CT, MRI, an angiogram or exercise testing may be considered.

A scan result is read alongside symptoms and other findings. NICE recommends specialist referral for moderate or severe valve disease and for bicuspid aortic valve disease of any severity. For some people with severe disease but no symptoms, changes in heart function or other test findings can prompt discussion of intervention before symptoms develop. Ask what your results mean and when they will be reviewed.

Tests may also help plan how a replacement can be delivered and whether another heart problem needs treatment. If a symptom appears during activity, describe what you were doing, how long it lasted and whether it has changed. Do not wait for a scheduled scan if new or worsening symptoms need urgent assessment; use the routes above.

A replacement aims to improve blood flow through a damaged valve and reduce the strain on the heart. It can improve symptoms and quality of life and reduce the risk of further heart damage, but improvement is not guaranteed and other conditions can still cause symptoms. NICE recommends offering intervention for symptomatic severe valve disease; timing and suitability depend on the whole assessment.

Mild disease without symptoms may only need monitoring. Medicines can help manage symptoms or associated conditions, but they do not replace a severely damaged valve. For selected people aortic valve repair or balloon widening may be considered. The choice depends on the valve and diagnosis: neither is a universal substitute for replacement. If no intervention is suitable or desired, ask about symptom relief and support.

Monitoring means agreeing who checks the valve, when to have another scan and what symptoms should trigger earlier contact. NICE recommends an individual review schedule for asymptomatic severe disease where intervention is suitable but not currently needed. Ask what could happen if treatment is delayed and how urgently the decision is needed in your case.

Surgical aortic valve replacement, often called SAVR, reaches the valve through a chest incision. The surgeon removes the damaged valve and fits a replacement. Access may be through the breastbone or a smaller incision in selected people. TAVI, also called TAVR, delivers a replacement valve on a catheter, usually through an artery in the groin; it is expanded within the existing valve, which is not removed.

NICE NG208 recommends suitable surgery as first-line for adults with severe aortic stenosis, regurgitation or mixed disease who have an indication for surgery and low or intermediate surgical risk. It recommends TAVI when suitable for severe non-bicuspid aortic stenosis in adults at high surgical risk or when surgery is unsuitable. The guideline includes cost-effectiveness in its recommendation; local availability and guidance may differ across UK nations.

This does not mean TAVI is interchangeable with surgery for every leaking or bicuspid valve. A specialist heart team assesses the anatomy, overall health and risks, and discusses preferences, durability, recovery, other heart procedures and possible future interventions. Ask why the proposed route fits your own valve, arteries and circumstances, and whether another option is available.

A mechanical valve is made from durable artificial materials and generally lasts longer. It can make a clicking sound. It also creates a risk of clots, so a person with a mechanical valve needs lifelong anticoagulation, usually warfarin, and regular monitoring. Anticoagulation reduces clot risk but increases bleeding risk.

A biological or tissue valve is made from human or animal tissue. It can wear out over time and another procedure may be needed. A tissue valve does not automatically mean lifelong anticoagulation, although another condition such as atrial fibrillation may require it. TAVI uses a biological valve. Ask about the likely durability for your age and the practical implications of a future intervention.

The choice is individual: age, other medical conditions, bleeding or clotting concerns, the ability to manage monitoring, possible pregnancy and personal preferences all matter. If pregnancy is possible or planned, discuss it before deciding; NICE recommends specialist advice for people with a prosthetic valve who are pregnant or considering pregnancy. Never change anticoagulation independently if pregnancy occurs.

Warfarin reduces clotting and requires blood tests called INR tests to guide the dose. Keep your anticoagulant alert card and tell clinicians and dentists about the valve and medicine. Other medicines, supplements and major dietary changes can affect warfarin. Check with your anticoagulation team before starting or changing them, and follow their instructions for missed doses or testing.

Do not stop, start or alter warfarin or other prescribed blood-thinning medicines on your own, including before dental work or another procedure. NICE does not recommend routine anticoagulation solely after surgical biological valve replacement when there is no other indication, and advises considering an antiplatelet such as aspirin after TAVI. Your own prescription can differ because of another condition or procedure. Ask which medicine you need, why, and for how long.

Bleeding and head injury need attention when taking warfarin. NHS England advises urgent 111 help for symptoms of bleeding or a head injury. Serious bleeding or stroke symptoms require emergency care. Use the nation-specific urgent routes above, and tell the clinician which anticoagulant you take.

Before treatment the team reviews your heart tests, general health, medicines and anaesthetic plan. Bring a list of prescriptions, over-the-counter medicines and supplements. Follow the hospital’s specific instructions on food, drink and medicines, and ask how the plan applies to anticoagulants. Discuss practical support at home and who to contact if your symptoms change while waiting.

Surgical replacement usually uses general anaesthesia. In open surgery the surgeon opens the breastbone and uses a heart-lung bypass machine to maintain circulation while the damaged valve is removed and the new valve is fitted. The breastbone is usually closed with wires. Some operations use smaller chest incisions but still require bypass. Ask which access is planned and whether another heart procedure is expected at the same time.

For TAVI, a catheter carries the valve to the heart, most often from the upper leg. It is commonly done with local anaesthetic and sedation; the anaesthetic and access route can vary. The heart usually continues beating and the old valve is left in place. Afterwards ask which valve was implanted, whether the procedure went as planned and what medication and follow-up you need.

Heart valve replacement can involve serious complications, including bleeding, infection, blood clots or stroke, heart rhythm problems and kidney injury. Some people need a pacemaker for a persistent rhythm problem. A replacement valve can later work less well or become infected. Risk varies with the person, valve, other health conditions and procedure; ask your team to explain your own risks alongside the risks of not intervening.

TAVI avoids a large chest incision but has its own possible complications, including bleeding or problems at the access site, valve leakage, stroke and rhythm problems that may require a pacemaker. A need for another intervention remains possible. The size of an incision alone does not describe the whole risk. Ask about your arteries, pacemaker risk, valve leakage and the team’s plan if a complication occurs.

The PARTNER 3 randomised trial compared TAVI with surgery in adults with severe, symptomatic aortic stenosis and low surgical risk. At five years it found no statistically significant difference between groups in its two primary combined outcomes, which included death, stroke and hospitalisation measures. This result does not establish that the procedures are identical for every outcome or person.

The trial studied selected patients and a particular transcatheter valve, not every valve design or person with regurgitation. Five years cannot settle valve durability over a younger person’s lifetime. The study was funded by the device manufacturer. Discuss how your situation compares with the participants and how the evidence sits alongside current local guidance.

After chest surgery you will usually be monitored in intensive care, with pain relief and temporary chest tubes. Staff help you breathe, move and begin walking. A stay of about a week is usual after surgical replacement; the NHS describes a shorter stay, often two to three days, after TAVI. Discharge depends on recovery and any complications, not a fixed timetable.

At home, tiredness and some discomfort can be expected initially. Follow the wound and activity plan, arrange help for the first few days and build up walking as advised. Cardiac rehabilitation may offer exercise and support. Recovery after chest surgery often takes two to three months; TAVI recovery is generally quicker. Ask the team about lifting, work, sex and exercise for your actual procedure and circumstances.

Driving depends on the procedure, recovery, licence type and medical advice. GOV.UK says car and motorcycle drivers should stop driving for at least one month after valve disease or replacement and resume only when their doctor says it is safe; bus, coach and lorry licence rules differ. Check your team’s instructions and current licensing rules, including local arrangements in Northern Ireland.

A replacement needs ongoing follow-up. NICE says the frequency and type of monitoring should reflect valve durability, other heart conditions, any remaining leak or concerns, and the person’s wishes. Ask who arranges reviews and echocardiograms, what valve you have and how to report a change in symptoms between appointments. A biological valve that deteriorates may sometimes be treated with another operation or a valve-in-valve procedure, depending on the assessment.

A replacement valve increases the risk of endocarditis, a serious infection of the heart lining or valve. A high temperature, shivering, night sweats, breathlessness or unexplained illness can be warning signs. Seek urgent advice and tell the clinician about the valve; do not wait for a routine review. Stroke signs need 999. Keep teeth and gums healthy and attend dental check-ups.

Tell your dentist and medical teams that you have a replacement valve and carry relevant valve and anticoagulant information. Antibiotic prevention before dental procedures is not routinely recommended by NICE; its guidance links to UK-endorsed advice for high-risk people. Ask your dentist and heart team what applies to your procedure rather than taking antibiotics or changing anticoagulants yourself.