Durability and Performance of the Replaced Valve

The ideal replacement valve provides excellent valve function and works in coordination with the entire circulatory system to protect each part from damage.

If you need to have your heart valve replaced, you have several choices to consider when discussing your valve options with your healthcare professional. The type of valve and the surgical approach impact both your short-term recovery and your long-term quality of life.

Possible Heart Valve Choices

Mechanical Valve

These valves are made from strong, durable materials. They are the most durable type of replacement valve. Most will last a patient's lifetime.

Patients who receive a mechanical valve will almost always need anticoagulant medication for the rest of their lives. The anticoagulant will prevent clot formation, which is essential because clots can lodge in the leaflets or hinges of the valve and cause malfunction. Clots can also break off and form an embolus, which can travel in the bloodstream and lodge in a vessel where it can cause problems such as a heart attack or stroke.

Mechanical valves are best for those who:

• are under 65 and want to avoid a second surgery when older;
• have overactive parathyroid glands, affecting blood calcium levels;

The downside is that mechanical valves can lead to blood clot formation. To reduce this risk, you will need to take an anticoagulant for the rest of your life, which increases the risk of bleeding.

Donor Valve

Human donor valves are often used for a person suffering from a condition like infective endocarditis. A donor valve can be expected to last 10-20 years.

Tissue Valve

Tissue valves are created from animal donor valves or animal tissues that are strong and flexible. Tissue valves may last 10-20 years and generally do not require long-term medication. For a young person who has had a tissue valve replacement, it is highly probable that they will need another surgery or valve replacement later in life.

For each surgery where the valve needs replacing, the durability of the valve, medication options, and risks should be carefully considered.

Tissue valves are best for pregnant women due to safety during pregnancy, but it's likely they will need to be exchanged later.

On the other hand, using a mechanical valve might increase risks during pregnancy, requiring you to take anticoagulants. Research shows anticoagulants can harm the fetus.

Heart Valve Replacement

Replacing a Stenotic Valve

The most common surgical procedure for aortic stenosis, or narrowing of the aortic valve, is aortic valve replacement. Mitral stenosis is another condition that may require valve replacement or repair.

Replacing a Valve Due to Aortic Regurgitation

Aortic regurgitation, or aortic insufficiency, is another common valve problem that may require valve replacement. Aortic regurgitation allows blood to flow backward through the valve and back into the heart instead of moving forward and out to the body. Aortic regurgitation can eventually lead to heart failure.

Mitral regurgitation, or mitral insufficiency, may also require valve replacement. In this case, the mitral valve allows oxygenated blood to flow back into the lungs instead of continuing through the heart as it should. People with this condition may experience shortness of breath, irregular heartbeat, and chest pain.

Surgical Options for Heart Valve Replacement

Ross Procedure

The Ross procedure is often very effective for treating damaged aortic valves. The aortic valve handles all the blood that is pumped to the body. The patient's pulmonary valve is similar in shape and can usually be "swapped" with the damaged aortic valve.

TAVI/TAVR Procedure

In this minimally invasive procedure, a new valve is inserted without removing the old, damaged valve. The new valve is placed inside the diseased valve. The surgery may be called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

The procedure chosen will depend on which valve needs replacing, the severity of symptoms, and the risk of surgery. Some procedures may require long-term medication to guard against blood clots.

Risks of Valve Replacement

The ideal replacement valve also offers long-term durability without significantly increasing the risk of dangerous blood clots.

Anticoagulant medications can reduce the risks of stroke or embolism (traveling clot) related to blood clots. The risks of clot formation are higher in people who have a mechanical valve. People on anticoagulants need to be closely monitored as blood that is too thin can increase the risk of bleeding.

Patients and their healthcare professionals should discuss treatment options and participate in the decision-making process to choose the most appropriate treatment.