Posted on June 25th, 2011 under Heart Valve Replacement, Surgeons & Clinics.
When evaluating surgical options for a heart valve replacement procedure, a common patient concern is selecting the “right” mechanical or tissue valve. Specific to this topic, Jenny recently wrote to me, “Hi Adam – I’m 38 years old and need aortic valve replacement surgery. The durability of a mechanical valve is attractive but it seems like so many people, of all ages, are getting tissue valves. Is that a trend that I should be paying attention to?”
I was very fortunate to ask Dr. Richard Shemin, cardiac surgeon and the Professor and Chairman of Cardiothoracic Surgery at UCLA Medical Center, this exact question. Here are the highlights from our discussion.
Thanks to Jenny for her question and a special thanks to Dr. Shemin for taking the time to discuss this important question with our community.
For those patients who are hearing impaired, I have provided a written, video transcript of my discussion with Dr. Shemin below.
Adam: Hi, everybody. It’s Adam and we are coming to you from the AATS convention in Philadelphia. I’m thrilled to be standing next to Dr. Richard Shemin who is from my hometown of Los Angeles. He’s the professor and chairman of cardiac surgery at UCLA. We’ve got a great question for Dr. Shemin. It’s from Jenny and she writes in, “Adam, at 38 years old, I need aortic valve replacement. The durability of the mechanical valve is attractive but it seems like so many people of all ages are getting tissue valves. Is that a trend that I should be paying attention to?”
Doctor Richard Shemin: Well, Jenny, I think at 38 years of age, clearly you should consider, if you need an aortic valve replacement, a surgeon that can do it minimally invasive. The second thing is, valve choice is a big decision. And I don’t really recommend looking into both pros and cons of tissue valves versus mechanical valves. There is no perfect heart valve, but if you’re undergoing a heart valve replacement surgery, whatever valve you choose should be better than the one you currently have. At 38 years of age, if you’ve finished having your family, you have so many wonderful years ahead of you, the mechanical valve will give you the durability that potentially you will never need to have that valve replaced but you will have to take lifelong anticoagulation and studying pros and cons and how to safely take anticoagulation is very, very important. Many of us recommend home testing devices in addition to follow-up with your doctor. The tissue valve, obviously, will give you the opportunity to have a valve which is almost maintenance free. You don’t have to take any special medication except for maybe an aspirin but, over time, that valve may deteriorate and a heart valve reoperation is standard. It can be done with low risk 10, 15, or 20 years later and some of the newer technologies that we have to percutaneously have advanced a catheter based valve in to the position and within the tissue valve that you may have implanted at this time would probably be a viable option. So, do your homework and I think you will get a good result. (To learn more about valve replacement, click here.)
Adam: Great. Well, I hope that helped Jenny. I know it helped me understand a little bit more and learn more. Dr. Shemin, as always, thanks for coming by. We really appreciate seeing you again and we’ll be talking to you hopefully in the near future.
Dr. Shemin, MD: And thank you for the service you provide to all of our patients helping to understand heart disease and how to find the right surgeon.
Keep on tickin!