ENAortic valve insufficiency treatment in Germany is not one operation but several ways of solving the same problem: repair, open replacement, replacement through a small incision or by catheter. What matters to a patient is how they differ, not what they are called.
This page covers when a leaking or narrowed valve really must be dealt with, how open surgery or a catheter procedure is chosen, which prosthesis is used and how long it all takes. For other conditions, see heart treatment in Germany.
When the valve is treated and when it is watched
The rule behind aortic valve insufficiency treatment in Germany: the valve is dealt with once it causes symptoms or starts to change the heart, and watched until then. A narrowed valve (stenosis) has stiff leaflets that let blood out of the heart only with difficulty; a leaking one does not close tightly, so some blood flows back after every beat.
A decision is forced by breathlessness on exertion, chest pain, fainting or growing weakness. Sometimes there are no complaints yet, but the left ventricle is already enlarging or pumping less strongly. This shows on an ultrasound scan (see echocardiography in Germany), and treatment is discussed without waiting for symptoms.
The decision rests on the whole picture rather than one number: doctors weigh the size of the valve opening, the pressure difference across it (the gradient), how the left ventricle works, age and other illnesses. The valvular heart disease guideline of the German Cardiac Society (DGK) takes the same approach.
Open surgery, a small incision or TAVI
All three are used in Germany. The classical operation runs on the heart-lung machine: the surgeon opens the breastbone, removes the valve and sews in a prosthesis, and experienced centres can sometimes repair a leaking valve instead. It remains the standard when something else must be done at the same time, such as a bypass.
A minimally invasive operation uses a small incision instead of opening the whole breastbone. In TAVI the chest stays closed: a catheter carries the new valve through a vessel, usually from the groin, and opens it inside the old one. Designed for people who would tolerate surgery badly, TAVI was first used only in older high-risk patients; its indications widened as trials went well, though for a leaking valve it remains an exception.
The choice falls not to one surgeon but to a team of cardiologist and cardiac surgeon, the Heart Team, which looks at the anatomy on CT, age, the access vessels and what else the heart needs. For a narrowed valve, the 2025 European guidelines recommend TAVI from 70 if the anatomy suits and open surgery below 70 at low operative risk, leaving other cases to the team. See also heart surgery in Germany.
Mechanical or biological prosthesis
It is a trade-off between durability and lifelong medication. A mechanical valve lasts for decades but needs lifelong blood thinning with a vitamin K antagonist and regular INR blood tests; a biological one, made from animal tissue, does not but wears out with time.
This is decided with the patient: younger people more often get a mechanical valve, and women planning a pregnancy are advised to consider a biological one. It matters whether regular INR tests or self-testing are practical at home, and whether a second procedure years later, possibly a catheter valve inside the worn biological one, is acceptable. There is no «best» prosthesis, only the right one for this person.
How long the hospital stay lasts and what follows
The stay has several stages, and discharge after a catheter procedure comes earlier than after open surgery. First the work-up: CT, coronary angiography, echocardiography and an obligatory dental check, since mouth infections must be treated before a new valve goes in. Then the procedure, days in intensive observation and on the ward, and a wound check, with stitches removed if needed, before discharge.
Then come cardiac rehabilitation in Germany, medication (lifelong after a mechanical valve) and echocardiography at discharge or soon after, then regularly. After open surgery the breastbone needs time to heal, so heavy lifting and driving are discouraged for the first weeks. For life, antibiotic cover is obligatory before tooth extractions or other work on the gums or tooth roots, to protect the valve from infection.
What documents a remote assessment needs
A remote assessment needs the echocardiography report with its measurements, coronary angiography or CT angiography, an ECG, discharge letters, the medication list and laboratory results. The fuller the set, the more precise the clinic’s answer and the less is redone on the spot.
It gives an opinion on the approach being considered and a preliminary estimate (costs are explained under heart surgery cost in Germany), but not the final decision, which follows an examination in person and the clinic’s own tests.
Frequently asked questions
Can a leaking aortic valve be repaired instead of replaced?
Sometimes. The European guidelines advise considering repair in experienced centres for selected patients with a severely leaking valve, when good long-term results are expected. It depends on the valve tissue and on how the valve leaks, judged from imaging; otherwise the valve is replaced.
Can TAVI treat a leaking aortic valve?
Only in selected cases. TAVI was developed for narrowed valves; for a leaking one, the European guidelines say it may be considered in symptomatic patients whom the Heart Team judges unsuitable for surgery, if the anatomy fits. For most such patients, surgery remains the main option.
Does a leaking aortic valve need treatment without symptoms?
Sometimes. If echocardiography shows the left ventricle enlarging or pumping less strongly because of the leak, surgery is recommended even without complaints. If the heart copes well, regular check-ups with repeat scans usually suffice; at low operative risk, surgery may be considered earlier.
How AlenMed arranges treatment
AlenMed handles the organisation, while the medical answer and the estimate come from the clinic directly. We send your documents to a heart centre, help with the visa invitation, agree the admission date, meet you on arrival and provide an interpreter at appointments and at discharge. Partner centres are listed under heart centres in Germany.
Plan ahead for a companion, the days needed before the procedure and after discharge (agreed with the clinic, as they depend on the method), follow-up at home by your own cardiologist, who should get the discharge letter and medication plan, and payment, which goes directly to the clinic.
This material is for information only and is not an offer. The indication and the method are decided by a doctor at an in-person consultation.
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