Aortic Valve Repair: When Is It Possible?
Written By: Allison DeMajistre, BSN, RN, CCRN
Medical Expert: Ioannis Loumiotis, MD, Director of Aortic Surgery, AdventHealth, Orlando, Florida
Reviewed By: Adam Pick, Patient Advocate, Author & Website Founder
Published: July 14, 2026
Patients with aortic valve disease who anticipate surgical intervention sometime in the near or distant future often begin to research and investigate whether a repair or replacement will be the best option. An aortic valve repair means keeping one’s own tissue, which is preferable. Unfortunately, the question of whether aortic valve repair is possible can be complicated and requires expert opinion.
We received a patient question on this topic from Elaine, who asked, “I have moderate aortic valve disease and am in the waiting room. From what I've read, it can be advantageous to keep my own tissue. How do heart surgeons determine if an aortic valve can be repaired and not replaced?” To answer Elaine’s question, Adam Pick, founder of HeartValveSurgery.com, met with Dr. Ioannis Loumiotis, the Director of Aortic Surgery at AdventHealth in Orlando, Florida. Dr. Loumiotis has performed over 1,000 heart valve operations and is a perfect candidate to answer Elaine’s question, given his expertise in aortic valve surgery.
Video available online at:
https://www.youtube.com/watch?v=LBHuXgfARcU
Facts About When an Aortic Valve Repair is Possible
Here are the key insights shared by Dr. Loumiotis:
Keeping the native valve has many advantages. Dr. Loumiotis stated, “How to reconstruct or repair a patient’s own aortic valve is one of the most important questions in aortic surgery today.” He explained that preserving the native valve is very valuable for patients because it prevents the need for lifelong anticoagulation and reduces the risk of infection. Additionally, there is a low risk of wear-and-tear injury that they would have with a tissue valve replacement.”
A thorough assessment of the aortic valve is required. “Not all valves can be repaired,” said Dr. Loumiotis. “As a surgeon, I tend to approach four different things when I evaluate a patient with aortic valve disease. Number one is the anatomy of the aortic valve. How does the valve look in the operating room? Does the valve have two leaflets, or is it a three-leaflet valve? Are the leaflets of the valve pliable and thin, or are they thick, fibrotic, and stenotic? The latter obviously precludes a successful repair of this valve. Is there a combined disease that will require more advanced repair?”
Valve function is another primary factor for assessment. “The second criterion that I use is to determine the mechanism of valve failure. Is there an aortic aneurysm that causes the valve to dilate, where the leaflets do not connect very well, or is calcification of the leaflets or annulus causing severe disease and affecting the valve's opening? Generally speaking, if we have good tissue quality but poor geometry, we can repair the geometry, and the valve will work very well.”
Valve imaging is important, but surgeon expertise is the key. “All of these questions can be answered by preoperative imaging,” said Dr. Loumiotis. “We do advanced imaging and have the answers we need before we go to the operating room. However, the most important test that we have as surgeons is the ‘Eyeball Test.’ A surgeon’s experience in the operating room is very important.” Dr. Loumiotis explained that a surgeon needs to see the valve and determine whether it can be repaired successfully or if the repair will not last long. “So, the surgeon’s experience should not be underestimated.”
Evaluating the patient is another critical factor. “The fourth thing I assess is patient factors that have nothing to do with the valve itself. How old is the patient? Is the patient’s functional capacity active or debilitated? Is the heart function good? These operations are long, and sometimes we might have to put a second cross-clamp on. We may have to go back and re-repair the repair, so the heart needs to have good function.”
Advice for patients considering repair or replacement. Dr. Loumiotis said, “Every patient with aortic valve disease should check with their cardiologist or primary care doctor to determine if the valve is repairable. If it is, find an expert surgeon or a center that performs a lot of these repairs. We know from the volume of outcomes that the more repairs a surgeon or center of excellence performs, the better the outcomes.”
Many Thanks to Dr. Loumiotis and AdventHealth!
On behalf of all the patients in our community, thank you, Dr. Ioannis Loumiotis, for everything you and your team are doing at AdventHealth in Orlando, Florida!
Related links:
Keep on tickin!
Adam
P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Loumiotis below.
Written by Adam Pick
Patient & Website Founder
Written by Adam Pick - Patient & Website Founder
Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.
Video Transcript:
Adam Pick: Hi, everybody. It's Adam with HeartValveSurgery.com, and we're at the American Association for Thoracic Surgery Conference in Chicago, Illinois. I'm thrilled to be joined by Dr. Ioannis Loumiotis, who is the Director of Aortic Surgery at AdventHealth In Orlando, Florida.
Adam Pick: Dr. Loumiotis, it is great to see you. And thanks for meeting with me today.
Dr. Ioannis Loumiotis: Thank you. Thank you for the invite.
Adam Pick: We're here at AATS, and we're learning a lot. New research is coming out about valve therapy.
We're also getting questions from patients coming at us from all over the world. This one comes at us from Elaine. And she asks, "Hi, Adam. I have moderate aortic valve disease, and I'm in the waiting room. From what I've read, it can be advantageous to keep my own tissue. How do heart surgeons determine if a aortic valve can be repaired and not replaced?"
Dr. Ioannis Loumiotis: Well, Adam, that's one of the most important questions nowadays in aortic surgery. How can you reconstruct or repair the patient's own native aortic valve? You offer something very valuable to the patient by keeping his native valve because you prevent anticoagulation, you prevent infections, and they have a low risk of wear and tear injury from a tissue valve they get.
However, having said that, not all the valves can be repaired. And as a surgeon, I tend to approach four different things when I evaluate a patient with an aortic valve disease. Number one is the anatomy of the aortic valve. How does the valve look like in the operating room? Does the valve has two leaflets or a three-leaflet valve?
Are the leaflets of the valve pliable and thin, or they are thick, fibrotic, and stenotic? The latter obviously precludes a successful repair of this valve. Is there a combined disease, mixed disease that requires more advanced repair? The second criteria that I usually use is what is the mechanism of the valve failure?
Is there an aneurysm that causes the valve to dilate and the leaflets do not coapt very well, or is there any calcification that affects the leaflets, the annulus, and causes severe disease, not opening the valve? If we have a good tissue quality, generally speaking, but the geometry is not good, we can repair the geometry, and the valve is going to work very well.
All of these questions, for the most part, can be attained by preoperative imaging. We do the advanced imaging. We have the answers that we need before we go to the operating room. However, the most important test that we have as surgeons is the “Eyeball Test”. A surgeon's experience is very important in the operating room to assess the valve and say, "You know what? This valve is repairable," or, "This valve repair is not going to last long." So the surgeon's experience should not be underestimated. It's very important And the fourth thing that I usually assess is the patient factors that have nothing to do with the valve itself per se, but has to do with how is the patient?
How old is the patient? Is the patient a young patient or an old patient? How is his functional capacity? Is he active or debilitated? How is the heart function? Is the function good? Because you know these operations are long. Sometimes you might have to put a second cross clamp on. You have to go back to re-repair the repair, so you have to make sure that these hearts have good function.
Adam Pick: Dr. Loumiotis, very helpful. I'm curious to know, what's your advice for patients out there who are considering a repair or replacement?
Dr. Ioannis Loumiotis: I would say to every patient who has aortic valve disease to always check with their cardiologist or the primary care doctor if this valve is repairable. And if it is repairable, try to seek out an expert or a center that they do these repairs a lot, because we know from the volume outcomes, the more you do it, the better outcomes you have.
This is very important for the patients to know.
Adam Pick: That is great advice. Elaine, I hope that helped you. I know it helped me. And Dr. Loumiotis, on behalf of Elaine and all the people in our community, thanks for everything you and your team are doing at AdventHealth. Thank you. Thanks for being with me today.
Dr. Ioannis Loumiotis: Thank you so much.
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