{"id":1209,"date":"2021-06-09T16:42:25","date_gmt":"2021-06-09T16:42:25","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=1209"},"modified":"2023-09-27T16:39:25","modified_gmt":"2023-09-27T16:39:25","slug":"mechanical-heart-valve-replacements","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/mechanical-heart-valve-replacements\/","title":{"rendered":"Mechanical Heart Valve Replacements: 13 Important Facts"},"content":{"rendered":"<p>When patients with severe heart valve disease are not candidates for a valve repair procedure, they will have different heart valve replacement options to choose from.\u00a0 There are biological devices including <a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/pig-valve-replacement\/\">pig valve replacements<\/a> and <a href=\"https:\/\/www.heart-valve-surgery.com\/cow-valve-replacement.php\">cow valve replacements<\/a>.\u00a0 There are human donor valves known as homografts.\u00a0 And, there are mechanical valve replacements made from advanced scientific materials including pyrolitic carbon.<\/p>\n<p>As many leading doctors have shared with the HeartValveSurgery.com team, there is no &#8220;perfect&#8221; heart valve replacement device. Each option &#8211; biological, human donor and mechanical valves &#8211; has a unique set of advantages and disadvantages related to durability, risk factors, re-operation rates, and the potential lifelong use of blood thinners.<\/p>\n<p>To learn more about mechanical heart valve replacements, we interviewed <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Aqeel-Sandhu-McHenry-Illinois.php\">Dr. Aqeel Sandhu<\/a>, the Surgical Director of the Bluhm Cardiovascular Institute at <a href=\"https:\/\/www.heart-valve-surgery.com\/hospital\/northwestern-memorial-valve-program\">Northwestern Medicine<\/a>, Northwest Region. During his remarkable career, Dr. Sandhu has performed 7,000+ cardiac procedures.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/Wd-2SH5qfCo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Key Learnings from Dr. Sandhu<\/h2>\n<p>Dr. Sandhu shared many insights in this video. Here are the key learnings we jotted down for patients to consider:<\/p>\n<ul>\n<li>Dr. Sandhu&#8217;s interest to become a cardiac surgeon began when he was just eight years old.\u00a0 As a youngster, Dr. Sandhu was fascinated by anatomy.\u00a0 Dr. Sandhu states, &#8220;I dissected everything under the sun.&#8221;\u00a0 Then, in the fourth grade, Dr. Sandhu had a special opportunity to observe an open heart procedure. In that moment, Dr. Sandhu decided that his life&#8217;s work would focus on cardiac surgery.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full\" src=\"https:\/\/www.heart-valve-surgery.com\/Images\/dr-aqeel-sandhu-heart-surgeon.jpg\" alt=\"Dr. Aqeel Sandhu\" width=\"700\" height=\"467\" \/>Dr. Aqeel Sandhu<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>There are typically three reasons patients need to have a heart valve replacement operation. Heart valves can become tight (stenosis). Heart valves can become leaky (regurgitation). Or,\u00a0 heart valves can become tight and leaky.<\/li>\n<li>Key indicators for timing a heart valve replacement procedure include echocardiography and symptoms. However, patients can be asymptomatic (without symptoms) and still need surgery.<\/li>\n<li>Dr. Sandhu encourages patients, who are not capable of having a valve repair, to discuss the benefits and potential concerns of the two main heart valve replacement types &#8211; mechanical and tissue valves.<\/li>\n<li>Mechanical valves can outlive a normal patient lifespan which is an incredible advantage. However, mechanical valves currently require the ongoing use of blood thinners, or anticoagulants, to prevent clotting on the valvular device. Without the use of anticoagulants, a blood clot can form on the valve which could ultimately cause a stroke.<\/li>\n<li>There is a common misconception about mechanical valves that they are made from metal.\u00a0 Dr. Sandhu informed us that mechanical valves are actually made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrolytic_carbon\">pyrolitic carbon<\/a> which is a hardened material that has anti-thrombogenic properties.<\/li>\n<li>Biological valves, or tissue valves, are made from a pig or cow and do not require the patient to be on blood thinners. However, biological valves have a finite life.\u00a0 Dr. Sandhu states, &#8220;Generally, tissue valves last about 15 years.&#8221;<\/li>\n<li>Dr. Sandhu uses the <a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000923\">American College of Cardiology (ACC) \/ American Heart Association (AHA) Guidelines<\/a> and evidence-based medicine to recommend certain types of heart valves for different types of patients.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/Images\/ACC-AHA-Valve-Guidelines-Shared-Decision-Making.jpg\" alt=\"ACC \/ AHA Guidelines\" width=\"600\" height=\"314\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>According to the ACC\/AHA Guidelines&#8230; If a patient is under the age of 50, a patient should consider a mechanical valve in the aortic position. If a patient is over 65, the patient should consider a tissue valve in the aortic position.\u00a0 For patients aged 50 to 65, the patient can consider either a mechanical or tissue valve.<\/li>\n<li>For the mitral valve position, according to the ACC\/AHA Guidelines, a patient under the age of 65 should consider getting a mechanical valve.\u00a0 Patients over the age of 65 should consider getting a tissue valve replacement in the mitral position.<\/li>\n<li>Interestingly&#8230; The idea that a mechanical valve replacement is a &#8220;one-and-done&#8221; procedure for patients, given their potential long-term durability, is only partly true.\u00a0 According to Dr. Sandhu, there is both an operation and complication rate with mechanical valves.\u00a0 Dr. Sandhu states, &#8220;The current re-operation rate for mechanical valves is 0.6% per year. In a younger patient, that amounts to a 10% chance that a patient will require a re-operation.&#8221; According to Dr. Sandhu, the re-operation rate for biological valves is higher but not much higher.<\/li>\n<li>Life expectancy is determined by several factors &#8211; not just the valve type. The actual disease and the effects of that disease on the heart&#8217;s ability to function is critical for patients to consider. The life expectancy for both a mechanical valve and a biological valve has been shown to be about 12 years as demonstrated in clinical trials and meta analysis. According to Dr. Sandhu, &#8220;Unfortunately, there is a misconception in people&#8217;s minds when it comes to understanding longevity and survival with biologic vs mechanical valves. It is intuitive to think that a tissue or biologic valve is less robust than a mechanical valve and would degenerate over time while a mechanical valve would not. However. the reality is for a 60-year-old man, simulated life expectancy in years for biological versus mechanical prostheses was 11.9 versus 12.2, event-free life expectancy was 9.8 versus 9.3, and reoperation-free life expectancy was 10.5 versus 11.9. Lifetime risk of reoperation was 25% versus 3%. Lifetime risk of bleeding was 12% versus 41%. Additionally, several studies have shown no survival difference between biological or mechanical prosthesis up to 15 years post valve replacement.<\/li>\n<li>The <a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04142658\">PROACT Xa clinical trial<\/a> is evaluating the use of the ON-X mechanical valve replacement without the use of warfarin as the anticoagulant. Instead, the patient can use Eliquis (apixaban) as the blood thinner. This is important because Eliquis is a pill, taken two times daily, that does not require ongoing any blood monitoring which is a key advantage for patients.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/Images\/on-x-mitral-valve.jpg\" alt=\"On-X Mechanical Valve\" width=\"240\" height=\"200\" \/>On-X Mechanical Valve<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Dr. Sandhu&#8217;s number one piece of advice for patients considering a heart valve replacement is to understand that there is no perfect valve yet.\u00a0 Patients need to research their options and have open conversations with their surgeons about the pros and cons of each valve type.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Many Thanks to Dr. Sandhu &amp; Northwestern Medicine<\/h2>\n<p>On behalf of our patient community, many thanks to Dr. Sandhu for taking time away from his busy practice to share his clinical experiences and research with us.<\/p>\n<p>In addition, we would like to thank the entire team at Northwestern Medicine for taking great care of our patients!<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Aqeel-Sandhu-McHenry-Illinois.php\">See Dr. Sandhu&#8217;s Interactive Surgeon Profile<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/hospital\/northwestern-memorial-valve-program\">Explore the Northwestern Medicine Heart Valve Microsite<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/mechanical-replacement-inr-home-testing\/\">Mechanical Heart Valve Replacements &amp; INR Home Testing: Top 11 Facts<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/mechanical-valve-patient-success-story\/\">37-Year Mechanical Heart Valve Replacement Patient Success Story: Allen Stendahl<\/a><\/li>\n<\/ul>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. For the hearing impaired members of our patient community, we have provided a written transcript of this video below.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[10],"class_list":["post-1209","page","type-page","status-publish","hentry","category-heart-valve-replacement"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/1209","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=1209"}],"version-history":[{"count":24,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/1209\/revisions"}],"predecessor-version":[{"id":3845,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/1209\/revisions\/3845"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=1209"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=1209"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}