The prognosis for patients with valvular heart disease has improved substantially over the past 15 years. A better understanding of the proper timing of surgery is one of the key reasons. In general, surgery for stenotic valvular disease can be delayed until symptoms appear. Conversely, in regurgitant valvular heart disease, prognostically important left ventricular dysfunction may develop in the absence of symptoms, and thus valve surgery for some asymptomatic patients is entirely appropriate. It is likely that in the future there will be progress toward increasing conservation of the patient's native valve. This will be beneficial because even modern prosthetic valves have inherent risks. Acquired aortic stenosis will often continue to require prosthetic aortic-valve replacement. However, valvular disease will increasingly be treated by procedures that conserve native valves. These include pulmonary autografts for aortic stenosis, balloon commissurotomy for mitral stenosis, mitral-valve repair for mitral regurgitation, and aortic-valve repair for aortic regurgitation. These procedures will make surgery more attractive by eliminating the risks associated with prostheses. Thus, continuing advances in noninvasive assessment of the aortic and mitral valves, appropriate timing of referral for surgery, improved surgical techniques for valve replacement and reconstruction, and very recent advances in less invasive surgical approaches should combine to improve the outlook for patients with valvular heart disease.
