What is the Durability of Mitral Valve Replacements?

Patients with severe mitral valve regurgitation or prolapse who need intervention to relieve symptoms usually have the valve repaired rather than replaced. However, the mitral valve can sometimes be irreversibly damaged by infection or calcification, and repair is no longer an option. At that point, the only alternative is a replacement with either a mechanical or tissue valve. Both are great options, but patients should understand the differences, particularly regarding valve longevity.

We recently received a patient question on our YouTube channel about this topic from Embrazil. She asked, “How durable are mitral valve replacements?” To answer that question, Adam Pick, founder of HeartValveSurgery.com, spoke with Dr. Marc Gerdisch while attending a conference at the Endoscopic Surgeons’ Club in Northern Kentucky. Dr. Gerdisch is the Director of Minimally Invasive Cardiac Surgery at Indiana University Health in Indianapolis, Indiana. He has performed more than 7,000 cardiac surgeries and specializes in complex heart valve disease and advanced valve repair techniques.

Video available online at:

https://www.youtube.com/watch?v=VXII5_o0tmI

Important Facts About the Durability of Mitral Valve Replacements

Here are the key insights shared by Dr. Gerdisch:

• Mitral valve replacement durability isn’t a common topic of discussion. “This is a very important question, and folks don’t focus on it as much because we’re always repairing mitral valves,” said Dr. Gerdisch. “The only time we replace a mitral valve is really for rheumatic disease or for people who have dramatic changes in the geometry of their ventricles, and the valve simply won’t function because of those changes. But we do have to replace mitral valves sometimes.”

• Valve durability is closely linked to heart pressure. Dr. Gerdisch explained, “The durability of a tissue valve in a mitral position is less than the durability of a tissue valve in the aortic position because, in the mitral position, the valve must deal with true systolic pressure. If the left ventricle generates a blood pressure of 130 over 80, the mitral valve sees the 130, whereas the aortic valve only sees the 80. So, the stress on the mitral valve is higher, and we think that’s the key reason they don’t last quite as long as the aortic valves do.”

• Patient age matters when choosing a mechanical or tissue valve replacement. “For tissue valves in the mitral position, we think in terms of a patient’s longevity,” said Dr. Gerdisch. “If we look at the literature, the reality is that mechanical valves serve patients up to just about 70 years of age, whereas in the aortic position, it’s more about 65 years of age. There’s also a gray zone around there, depending on patient comorbidities and willingness to be on anticoagulation-which is a completely separate conversation. It’s important, though, to recognize that the tissue valve in the mitral position will not last as long. Looking at the overall performance of tissue mitral valves, it’s probably on the order of a decade and less in younger patients.

• Specific patient factors influence valve longevity. “Things that affect the durability of the valve include how big the valve is; a bigger valve lasts longer.” Dr. Gerdisch explained that patient comorbidities also affect durability. “If the patient has cardiometabolic disease or diabetes, those things influence the durability of a tissue valve. Most importantly, though, is patient age. The younger the patient, the shorter the valve lasts. If we put a tissue valve in a 40-year-old, it might only last eight years, and then that patient will need another valve operation at 48. Another important point is that redo mitral valve surgery is more difficult than redo aortic valve surgery. These are all important things to consider. Patients should think about a mechanical valve in the mitral position, especially those who have longevity.”

Thanks, Dr. Gerdisch and Indiana University Health!

On behalf of all the patients in our community, thank you, Dr. Marc Gerdisch, for everything you and your team are doing at Indiana University Health in Indianapolis, Indiana.

Related links:

• Learn More About Dr. Gerdisch on his Interactive Surgeon Profile

• Check Out the Indiana University Health Microsite

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Gerdisch below.