Heart prosthetic valve choices

Hello doctor,my father is 56 yrs old and need an aortic valve transpalnt for AI.I wanted to ask dat at dis age which valve will be gud for him,tissue one or metallic one.i also wanted to know wat is d average life of a gud quality biological valve.At sm places i hv read 10 yrs while at sm 15 and sm even say 20yrs.I am really confused,please help.thank u.
Hi Amrita,
There are a lot of considerations about the treatment of aortic valve disease, and especially aortic insufficiency:
  1. An aortic valve repair should be considered first. If possible, this is the best solution, but it requires an experienced surgeon.
  2. For aortic valve replacement the choice between tissue vs. a metal valve depends first of all on
    1. Whether there are cardiac Arrhythmias such as atrial fibrillation that requires long-term anti-coagulation with a blood thinner such as Coumadin.
    2. Is an adequate size valve prosthesis possible (a tissue valve requires more space), and if not, can the area be enlarged to accommodate a larger prosthesis?
    3. A metal valve prosthesis has a smaller diameter (thus fits easier) and lasts forever, but is more prone to the risk of an infection and requires a blood thinner for the rest of your father's life - an issue if he is involved with activities that may expose him to injuries and thus bleeding.
    4. A tissue valve is larger (thus a good size sometimes not possible without additional surgery), lasts about 15-17 years and will need to be replaced eventually if your dad lives long enough. Blood thinners in someone with a normal rhythm usually only need to be taken for about 6 months.
  3. Is there associated coronary artery disease for which Coronary artery bypass grafting is needed?
  4. How physically active and healthy is your father? 
  5. What is his normal life expectancy once his valve has been fixed?

With all that in mind, I'd probably recommend a tissue valve if repair is not possible, because if could avoid long term blood thinner use and the risk of a future re-replacement of the prosthesis is relatively small in an otherwise healthy person. A new procedure called trans-catheter aortic-valve implantation (TAVI) has recently been developed for patients who are otherwise too sick to survive convential open heart surgery. Your father is not a candidate for that operation but might be in the remote future.

Hope this helps,

Dr T




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