Submitted by Dr T on November 7, 2013 – 5:04pm
The question is not what mechanical heart valve is best. That’s your surgeon’s decision, and it depends on his personal experience. The real question is whether a mechanical valve is preferable over a tissue valve, or whether a repair is possible.
The first questioon is about what valve needs to be fixed, the mitral or aortic valve.
There are a lot of considerations about the treatment of aortic valve or mitral valve disease, and especially mitral insufficiency and aortic insufficiency:
- An aortic valve repair or mitral valve repair should be considered first. If possible, this is the best solution, but it requires an experienced surgeon.
- For both mitral and aortic valve replacement the choice between tissue vs. a metal valve depends first of all on
- Whether there are cardiac arrhythmias such as atrial fibrillation that requires long-term anti-coagulation with a blood thinner such as Coumadin.
- 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?
- 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.
- 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.
- Is there associated coronary artery disease for which Coronary artery bypass grafting is needed?
- How physically active and healthy is your father?
- 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 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. Hope this helps,