Mechanical Or Bioprosthetic Heart Valve Replacements?
Earlier today, Helia wrote to me, “Adam - I have been diagnosed with severe aortic stenosis. My cardiologist recommends surgery within the next two months. I’m confused by everything right now. Especially, I’m confused by all the different types of valve options. Which is better for me - a mechanical or bioprosthetic heart valve replacement?”
I really feel for Helia. In fact, I feel for all patients that are going through the very, very, very, very awkward and fearful experience of being diagnosed with heart valve disease. As I remember, it’s not fun.
Still, I’m not going to wallow in the negative because I know that heart valve surgery is a medical miracle for most patients that need valve repair or valve replacement.
On-X’s Mechanical Heart Valve
As for Helia’s question of, “Should I get a mechanical or bioprosthetic heart valve replacement?”, that is a great question. As you would imagine, selecting a heart valve replacement - mechanical or bioprosthetic - is not unlike selecting anything else (a car, a home, a new computer, or even a spouse). There are trade-offs, or pros and cons, for both mechanical heart valves and bioprosthetic heart valves (including pig valve replacements or cow valve replacements).
Here are some of the key advantages and disadvantages of mechanical heart valves, as shared with me by several patients and caregivers:
- Advantage - Mechanical heart valves are very durable because they are made of strong materials like carbon, titanium, Teflon, polyester and dacron. As I’ve written, some mechanical valves are still ticking 38 years after implant. Because these valves are so durable, the patient risk for future valve replacement re-operations is decreased.
- Disadvantage - To prevent a risk of blood clots forming on the valve, blood thinners are used by patients for the balance of their lives. The anticoagulant, Coumadin, is the most common drug therapy used by mechanical valve replacement patients. Some patients have no issues with the ongoing monitoring (prothrombin time level) and consumption of Coumadin. Others, feel that there are some risks associated with Coumadin. (Please note that some mechanical valves - specifically the On-X Mechanical Heart Valve Replacement - are being tested for lower or no Coumadin intake post implant.
- Disadvantage - Mechanical heart valve replacements are known to loud and noisy in some patients. That means the patient, and the people around them, can hear a “clicking” noise as the valve opens-and-closes in the heart.
As for bioprosthetic heart valve replacements, here are some of the key advantages and disadvantages:
- Advantage - The patient is not required to use Coumadin after surgery.
- Advantage - The valves do not click, therefore patients can not hear them.
- Disadvantage - The bioprosthetic valves are made from a pig’s heart valve and a cow’s heart tissue. That said, the bioposthetic valve are not as durable as mechanical valves. Pig valves last between 10-15 years while cow valves can last beyond 20 years in some cases. That means a young patient receiving a bioprosthetic valve may require another operation later in life.
The information shared above is not exhaustive for why a patient might select a mechanical or bioprosthetic heart valve replacement. It is intended to show some of the trade-offs for patients considering heart valve replacement selection. Please take the time to discuss this topic with your surgeon, cardiologist and your support group.
I hope this helped explain a little more about mechanical and bioprosthetic heart valve replacements.
Keep on tickin!
About The Author: Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery. This unique book integrates the clinical facts of heart valve surgery with the personal experiences of 78 former valve surgery patients to help patients and caregivers better understand the problems, the opportunities and the realities of heart valve surgery. To learn more about Adam and his heart valve surgery book, click here.
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January 14th, 2009 at 4:12 pm
Adam,
FYI: There is one other problem with mechanical valves. If anything goes wrong they cannot go in and safely fix the problem.With human like tissue, they have more options. This is especially important for people who have small heart valves to begin with since they are at risk for patient-prosthesis mismatch.
Children can have many redo replacements throughout their lifetime…….therefore
they replace them with tissue and not mechanical valves.
I never read about patient-prosthesis mismatch when choosing my valve.
January 25th, 2009 at 1:23 pm
i am a truck driver. Wil i be able to drive big rigs or not? They are going to replace the valve in feb, 2009
March 24th, 2009 at 10:32 am
Has anyone out there who had a pig valve implanted undergone a subsequent valve replacement surgery? If so, was it worth it the first time to get the pig valve, skip the Coumadin, and have the second operation, or would you have rather had the mechanical valve in the first place (with the Coumadin) and skipped any subsequent surgeries?
April 27th, 2009 at 9:55 am
Hi Lucy, I made the decision to have a pig (aortic) valve put in in 1987 (I was 48) and I was coumadin-free and able to do everything I wanted to do for 18+ years, when the valve started to go. In 2005, I had the aortic valve replaced with a calf valve (while they were there, they also replaced the mitral valve, which was wearing out, with a calf valve) — Cleveland Clinic rocks!!!. Because I developed a case of atrial fibrillation, which couldn’t be eliminated, I have had to be on coumadin for the past 3 years. It’s not as annoying as I thought it might be, going for regular pro-time checks. If I had to do it all over again, I’d do it exactly the same way. Hope this helps you make your decision. Good luck! -joe-
April 27th, 2009 at 7:27 pm
Your information, Adam has always been of great help to us all, and your comparison of tissue vs. mechanical valves is right on target. I opted for the tissue (bovine) valve and have not regretted it. I hope it lasts me 20 years before I need further treatment or surgery. Keep up your good work and support for us all ….we appreciate all that you do.
Bill
May 28th, 2009 at 4:35 am
Mechanical valve verses bioprosthetic valve. My cardiologist and surgeon explained it this way “A preserved animal valve will last around 15 years which means that at 61 years old you will be 76 years old. You may not want to go through open heart surgery again or you may not be well enough for us to perform the surgery. On the other hand a mechanical aortic valve will see you out but on the downside you have to take warfrin religiously every day for the rest of your life.” I wasn’t too keen on taking “rat poison” but as my good wife rightly said, “Aliitle price to pay. Get over it!” The surgery was a breeze even though my surgeon said, “I would feel like I was it by a Mac truck.” Both choices have their fores and against - be guided by your professional medical teams advice. After all they are offer you life!!!
Roger
July 2nd, 2009 at 3:39 am
I was just told I need a double bi-pass and a new heart valve. I am 60years old and have my own handyman business… which means I tend to have minor cuts all the time. I am concerned that if I choose a mechanical heart I would then be on coumadin. Should this be a concern?
Thanks for the input
peter k
August 9th, 2009 at 4:58 pm
mecanical heart valve since 1995 implanted at the same time as I had a single coronary by-pass. On Coumadin with regular anticoagulation checkups every 6-8 weeks. I am 64, male. I have a couple of episodes of bleeding, one of which possibly led to a stroke which affects ny right side.
i
October 28th, 2009 at 1:59 am
I am a heart surgeon.To answer helia’s dilemma ..I would choose a Bioprosthetic valve,reason being I will have to put my patient on low dose anicoagulation,they can have a very normal life style,can plan pregnancy,without the risk of discontinuing warfarin and starting on heparin.
Secondly even if they do undergo structural deterioration ,patient gets ample time to plan the re-do surgery which is quite safe vesus the risk of dropping dead if the disc of the mechanical valve were to just fail to open.This is a class 3 indication but a strong one as against the uncertainty of mechanical valve and risk of high dose anticoagulation!