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Valve Choices for Open-Heart Replacements

Valve Choices for Open-Heart Replacements

Traditional open-heart surgery to replace damaged heart valves is still the optimal procedure for patients whose conditions make this surgery manageable. And, for valves other than the aortic valve, it's the only option. This procedure requires the surgeon to divide the breastbone and open the heart or the aorta. The heart is temporarily stopped, and a heart-lung machine circulates blood through the body.

Most open heart valve surgeries are performed to address narrowed valves (stenosis), leaking valves, or valves damaged by calcification or rheumatic disease. The mitral or aortic valves are most commonly replaced, but a surgeon can replace any of the heart's four valves. Some patients have damage to more than one valve and may require multiple replacements.

Open valve replacement surgery can use either mechanical or biological valves.

Mechanical valves, made of synthetic materials like carbon, can last for many years, even a lifetime. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood thinning medications (anticoagulants such as Coumadin) for the rest of their lives and have their blood checked regularly.

Biological valves are made from tissue, most commonly from a pig (porcine valve) or a cow (bovine valve). Tissue valves are beneficial because they closely mimic natural valves and typically do not require anticoagulant medication, which may improve quality of life. These valves are not as strong as mechanical valves, though, and they need to be replaced every 10 to 15 years.

In some cases, a human aortic valve can be implanted (homograft) - this option compares to the durability of animal tissue valves. Another procedure for aortic valve replacement is the Ross procedure, which involves replacing the aortic valve with the patient's own pulmonary valve. A pulmonary homograft is used to replace the patient's pulmonary valve. This procedure, used primarily for children, enables the new aortic valve to grow as the child does.

David Liu, MD

"The type of valve that is chosen may depend upon the age and condition of the patient," says David C. Liu, MD, a cardiac surgeon in the CardioVascular Institute at Beth Israel Deaconess Medical Center. "Tissue valves can last up to 15 years or more in an older, less active patient, but they tend to have a shorter lifespan in younger patients. For this reason, mechanical valves are generally preferred for younger, more active patients. While these patients will require an anticoagulant for their mechanical valves, they can still maintain an active lifestyle. They will need to avoid activities with a high risk of injury, however."

Most patients over the age of 70 are provided with a tissue valve, according to Liu.

"If the patient is 60 to 70 years old, they can likely choose the type of valve they receive based on preference," he explains. "These patients can discuss with their surgeons to determine which type of valve is optimal."

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted August 2012