Aortic Valve Replacement (AVR)-Which Valve is Right For You?

Having an Aortic Valve Replacement: Which Replacement Heart Valve is Right for You?

There are many factors which go into the consideration of which heart valve is right for you when you are faced with heart valve replacement.  Age, lifestyle, occupation, general health and support systems all play significant roles in determining which valve to choose.  The most important factors will require you to have a basic fund of knowledge so that you may have an intelligent conversation with your surgeon in an effort to find the right fit for you.  Understanding the similarities and differences of all of the products on the market is essential in making an educated decision about which valve to choose.  On tis page, we will examine some basic differences between mechanical and tissue valve prostheses, and in subsequent posts, we will examine the nuances of each in more depth.

Part 1:  Advantages and disadvantages of Mechanical Heart Valves

Mechanical heart valve Advantages:

  • Last a lifetime when anticoagulation (blood thinners) is well controlled and there are no related complications.
  • Re-operation rates are lower than those of tissue valves.
  • More efficient in small aortic sizes than many tissue valves.
Aortic Valve Replacement

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Mechanical heart valve disadvantages:

  • These valves require lifelong anticoagulation with warfarin (a common blood thinner).  Fluctuations in anticoagulant (blood thinner) medication level can cause clots to form which can block valve motion (thrombosis) or can travel and cause damage to vital organs (causing stroke).
  • Fluctuations on the high side can cause bleeding in vital organs such as the brain (stroke).
  • Pannus ingrowth (build up of scar tissue around the base of the valve) can occur and block leaflet motion leading to thrombosis resulting in stroke or  abrupt valve dysfunction which is usually life threatening.
  • Valve noise can cause sleep disturbance

Part 2: Advantages and disadvantages of Tissue Heart Valves

Tissue heart valve Advantages:

  • Aortic Valve Replacement (AVR)Many tissue heart valve recipients do not ever require anticoagulant medication beyond aspirin, and others only have to take it for about three months after surgery.  This is especially important for patients who live active lifestyles, have seizures, or have an occupation that puts them at risk for cuts and bruises.
  • New tissue treatments allow valves to last longer and longer without ever having to be replaced.  Data shows that most commercially available tissue valves can last 15 years or more without being replaced.
  • Tissue heart valves are very quiet.

Tissue heart valves Con’s:

  • Tissue valves may eventually wear out and have to be replaced. In general, structural degeneration due to calcification can lead to perforations and tears in the valve leaflets causing leakage.  This is generally a slow process that eventually requires surgery, but may be managed over long periods of time without intervention.
  • Most tissue valves can be expected to last 15 years or more, depending on the patient, before they must be replaced.
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