“What About Horse Valve Replacements?” Asks Joseph

By Adam Pick on October 21, 2010

I just received a very interesting question from Joseph about the different types of tissue heart valve replacements.

Joseph writes, “Have you ever heard of any surgeon using equine tissue valves for aortic valve replacement? In the 10 months of researching my aortic valve disease, I’ve not heard of EQUINE valves being implanted — not once. Can you provide some insight? Thanks, Joseph”


Animated Of ATS 3F Aortic Bioprosthesis Valve Video
ATS 3F Bioprosthetic Aortic Valve – Equine Tissue Valve


As Joseph suggests in his question, most discussions about tissue valve replacements focus on pig valves (porcine) or cow valves (bovine). However, an interesting fact is that equine tissue valves do exist. I recently learned a lot about horse valve replacements during a tour of a Medtronic assembly facility in Irvine, California. Medtronic manufactures an equine valve replacement known as the ATS 3f Aortic Biprosthesis valve replacement (shown above).

The valve leaflets of an ATS 3f device are developed from the pericardium (the sac surrounding the heart) of a baby horse. This manufacturing approach is somewhat similar to that of bovine valves – which utilize the pericardium of a baby cow. Alternatively, porcine valves use the actual structure of a pig.


ATS 3f Bioprosthesis


As for the surgical implantation of this particular horse valve replacement, it has been utilized by several surgeons since its commercial introduction in 2008.

  • Dr. Allan Stewart, MD, noted, “The ATS 3f Aortic Bioprosthesis is the only tissue valve that preserves the sinuses and restores native valve stress distribution and physiologic flow to the entire aortic root”.
  • Also… You may recall that this stentless device was implanted in the first two, robot-assisted aortic valve replacement surgeries.

I hope that helps Joseph (and perhaps you) learn a little more about horse valve replacements, also known as equine tissue valves.

Keep on tickin!

Written by Adam Pick
- Patient & Website Founder

Adam Pick, Heart Valve Patient Advocate

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Bob says on October 21st, 2010 at 4:32 pm

I think most people would be eager to know the performanace and the resilience of the equine valves. It’s nice to know it exists but more information on its characteristics will be helpful.

Jerry says on October 21st, 2010 at 5:13 pm

It would put a bit more gallop in his step, but I’d be worried about the trots.

Joy says on October 23rd, 2010 at 9:50 am

My aortic valve was replaced with the ATS 3f at the Austin Heart Hospital on 7/21/10 by Dr. John Oswalt. When he went over the various valve options with me, he pointed out that this one had been in use in Europe for around 8 years. Although that is not long enough to be sure it will perform as expected (15-20 years), so far it is doing well. He also indicated that there may also be some advantage to the stentless design – if I understood his explanation correctly, the stent can be where a valve fails when it does ultimately fail. So, not having a stent might be a good thing. I wish you the best with your research, Joseph. Thanks to Adam for this site & his book which helped me immensely in preparing for surgery.

Tom Brighi says on March 29th, 2011 at 8:18 pm

Thank Goodness I came across your blog on the ATS 3f Aortic Bioprosthesis (Horse valve replacement by Medtronic) and your interview with Dr. Allan Stewart. This valve and the fact that it showed so much promise in design, durability, and future replacement via trans-catheter procedure more than intrigued me. On 02/17/2011 I had heart surgery at St. Luke’s Episcopal Hospital in Houston TX to replace my aortic valve. Dr. James J. Livesay of the Texas Heart Institute performed the surgery and I chose the ATS 3F equine valve. On March 14th I had my first echocardiogram and it was spot on. No leakage, and as all the information I was able to get my hands on prior to my decision to use the ATS 3f Aortic Bioprosthesis stated, as close to a native valve as I could get. My Cardiologist, Dr. Andrew Civetello stated, “It is very difficult to tell the difference between a native valve and the ATS 3f”. I understand that there is no long-term data available, however, to this point I am satisfied with my choice

Becky Sandness says on June 14th, 2011 at 12:08 pm

As a cardiac surgery nurse I have a question regarding how the equine valves are obtained. Are these animals raised specifically for the use of their valves or is there some type of screening for obtaining their valves? We are interested in finding out more information on this subject. thank-you for your time.

B, Garcia says on July 4th, 2011 at 12:01 pm

I had my equine valve 3 weeks ago. I had been doing fine, but this week I have had my heart rate go up. Could caffeine affect my heart rate? I was not told what not to eat, I did start some therapy and was told to watch my heart rate and not let it go over 125. Has any one had these problems?

Kevin Hightower says on July 4th, 2011 at 2:30 pm

Caffiene is the most commmon stimulant and all stimulants raise the heart rate. I would not intake any sort of caffiene until you call your doctors office and find ask about your diet and about caffiene. If they did not tell you these things, If I were you I would call that Dr’s office immediately and ask those questions. God Bless.


SarahKing says on January 22nd, 2014 at 4:48 am

i was wondering if you can help I am doing about the horse’s heart in my course I was asking if you can give me some information about it for me

Ron Danaht says on February 12th, 2014 at 10:11 pm

I had the 3f put in, in Dec 09 I woke from the surgery feeling better than I had in years. Now hear we are feb/14 and my valve is leaking bad enough I can feel it. I go back to see my surgeon next week to see what is going on with it . I will update when I find out what is going on

Tom Brighi says on February 17th, 2014 at 1:15 pm

Sorry to hear about your issue… Hope you get some good news from your surgeon! I’m celebrating 3 years with my 3f today… Just got back from my Doc this morning and so far so good… Keep us posted on your condition and if there are any concerns with the 3f… Thought and prayers…

Pat DeBruce says on July 29th, 2014 at 12:01 pm

My Aortic Valve was replaced on July 16, 2014. I feel soooo much better! I do have an equine valve. I am grateful that one of the Creator’s wonders gave me the gift of life.

Beth says on June 18th, 2015 at 9:17 pm

I had the 3f valve put in March, 2012. It did not perform well in my case. There was very bad leakage and I just had it replaced with a bovine valve. My surgeon is one of the best in the country, so I have no doubt about his skill. I think there needs to be more study on the 3f valve.

crookedstick says on January 22nd, 2016 at 8:50 pm

So where are you getting the “baby horses” to rip out their hearts?

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