Should valvular replacement be reserved for symptomatic valvular heart disease?

Valvular replacement should generally be reserved for patients with valvular heart disease who are symptomatic. With the exception of an occasional case of tight aortic stenosis, morbidity and mortality are less in the asymptomatic patient managed medically versus surgically with prosthetic valve replacement. Therefore, patients with valvular lesions are best managed without prosthetic valve surgery until less than ordinary exertion makes the patient clearly symptomatic. At this point, significant hemodynamic impairment at rest is present, and the prognosis is worse if the patient is managed medically rather than surgically. Until then, however, one should not operate on an asymptomatic or minimally symptomatic patient with valvular heart disease, particularly when the surgical procedure can be expected to require valve replacement.