If you need to have heart valve surgery, you have several options to consider when discussing the planned procedure with your surgeon. Your options include mechanical valve replacement, tissue valve replacement, valve repair, or sometimes an alternative in selected cases.
Your options include:
Mechanical valves are made of strong durable materials. They are the most long-lasting type of replacement valve, and most of these manufactured valves will last a patient’s lifetime.
Patients who receive a mechanical valve will be required to take a blood-thinning medication (warfarin) for the remainder of their lives. The blood thinner stops clots from forming, which is critical for a person with a mechanical valve because clots can lodge in the valve flaps or hinges and cause a malfunction. Clots can also break off and form into an embolism (traveling clot), which can move through the bloodstream and lodge into a vessel sometimes leading to problems like a heart attack or stroke. It is extremely important that patients with mechanical valves take warfarin every day and have regular blood tests to monitor the drug. Some people are not very good at doing this, and mechanical valves are not a good choice for these patients.
The other question patients often have about a mechanical valve is, “Will I hear the valve tick?” Mechanical valve replacements are known to make a ticking sound while tissue valves are silent. It is a ticking sound as the valve opens and closes, and is best compared to the sound of a ticking of a watch. While older mechanical valves were quite loud, the newest generation of valves are almost as quiet as tissue valves.
Tissue valves (sometimes called bioprosthetic valves) are manufactured from a mixture of artificial material and animal tissue — either a pig’s heart valve (porcine valve) or tissue from the sac around a cow’s heart (bovine pericardial valve). The major advantage of a tissue valve is that patients do not need to take warfarin long-term (warfarin may be required for 3 months after surgery).
However, tissue valves do wear out over time, and they wear out more quickly in younger and more active patients. As a result, if a younger patient receives a tissue valve he or she is likely to require a further procedure on the valve in the future (possibly surgery, possibly a catheter-based procedure).
Older patients or those in whom surgery may be very risky may be considered for an alternative form of valve replacement performed via catheter (transcatheter aortic valve implantation, TAVI).
In some patients, particularly those with mitral regurgitation (a leaking mitral valve), it may be possible to repair the native heart valve without needing to replace it. The advantages of a repaired valve in comparison to a replaced valve is that this preserves the patient’s own tissue which may be more durable than a tissue valve replacement, while avoiding the need for long-term warfarin. A repaired valve may also be closer to a native valve in function which may be better for more active patients.
In very selected patients, particularly young active individuals, the best option for aortic valve replacement may be the patient’s own pulmonary valve, which is transplanted into the aortic valve position while the pulmonary valve is replaced with a donor valve. This is called a Ross procedure and the advantages and disadvantages of this need to be discussed in detail.
Which Valve to Choose?
Your surgeon will be able to discuss all the benefits and risks specific to you and help you make the right choice to best suit your lifestyle.