Surgeon Insights: Tissue & Mechanical Heart Valve Replacement Durability

Patients face numerous decisions when learning they need a heart valve replacement. Perhaps one of the most consequential decisions patients will make is whether to replace their diseased valve with a tissue or a mechanical valve. Although several factors must be considered before making a decision, including age, overall health, and lifestyle, there is no question that valve durability is one of the biggest patient concerns.

We get a lot of durability-related questions from our community. For example, Ravi just asked us, “Are there any new updates or research on what patients can do to enhance the durability of their heart valve replacement? I recently received an Edwards INSPIRIS RESILIA valve.” To answer Ravi’s question, we met with Dr. Doug Johnston, the Chief of Cardiac Surgery at Northwestern Medicine in Chicago, Illinois, who is a world-renowned expert in heart valve therapy.

Patient Considerations for Valve Replacement Durability

Here are the key insights shared by Dr. Johnston:

• There are two primary ways in which tissue valves can fail. “It’s a great question from Ravi and one patients often ask us,” said Dr. Johnston. “The truth is that there is not a lot you can do to make your valve last longer, or on the flip side, there’s not a lot you can do to screw it up. So, that’s the good news. All tissue valves typically fail one of two ways: either the leaflets tear, or more commonly, they develop calcification.”

• Modern generation valves are designed to last longer. “The specific valve you received, the RESILIA tissue treatment, is designed to reduce the rate of calcification over time. So, you have a modern generation valve. The hope is that it will last a very long time, but you don’t need to worry about anything you do in your daily life that might affect the durability.”

• How long do tissue valves last? Dr. Johnston said that the length of time tissue valves will last is very dependent on patient factors. “The most important one is age. For reasons we don’t fully understand, tissue valves tend to wear out more quickly in younger patients. It’s likely because the body’s metabolism of calcium is more active in younger patients. It may have a little to do with the immune system, but the younger you are, the faster the valve wears out.” Dr. Johnston explained that patients with a bicuspid aortic valve typically receive an aortic tissue replacement valve at around 50 or 60 years old, and they’ve found that these valves last about 15 years. “We know that, at least for the older generation pericardial valves, at 10 years, more than 90 percent of them are still working. At 15 years it’s about 70 percent, and by 20 years it’s down to 50 percent, which is not too bad for a prior generation valve.”

• Patients often ask the same question about the durability of mechanical valves. “Theoretically, a mechanical valve can last a human lifetime,” said Dr. Johnston. “The machine is amazing. The question is, how well is it maintained? I often tell patients it’s sort of like a high-priced sports car, like it needs a lot of maintenance to work well. If patients take their anticoagulation, their Coumadin, and regulate their dosing well, a mechanical valve can last 40 plus years. I’ve taken out mechanical valves that are as old as 45 years. The maintenance is very important, though. Before choosing a mechanical valve, I always discuss it with patients and let them know that it is a lifelong decision they must make. They need to look in the mirror and ask themselves if this is something they’re willing to take care of for the rest of their life. If they are, it’s a great choice.”

Thanks Dr. Johnston and Northwestern Medicine!

On behalf of all the patients in our community, thank you, Dr. Douglas Johnston, for everything you and your team are doing at Northwestern Medicine in Chicago, Illinois!

Related links:

• Survival Rates of Minimally-Invasive vs. Sternotomy with Dr. Doug Johnston
• Ask Dr. Johnston: How to Avoid Bacterial Endocarditis Infection at the Dentist?
• See Patient Reviews for Dr. Doug Johnston

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. Johnston below.