From the Guidelines
Biologic valve materials are recommended for patients of any age requiring valve replacement for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired, with a preference for bioprosthetic valves in patients over 65 years of age. The selection of prosthetic valve type should be based on a shared decision-making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risks associated with valve reintervention 1. For post-operative management, anticoagulation with warfarin is generally recommended for 3 months following bioprosthetic valve implantation in the mitral or tricuspid position, while it's optional for aortic valve replacements depending on patient risk factors. After this initial period, lifelong aspirin (75-100 mg daily) is typically sufficient for most patients with bioprosthetic valves.
Some key points to consider when choosing biologic valve materials include:
- The patient's age, with bioprosthetic valves preferred in patients over 65 years of age 1
- The patient's ability to manage anticoagulant therapy, with bioprosthetic valves recommended if anticoagulant therapy is contraindicated or cannot be managed appropriately 1
- The patient's lifestyle and preferences, with bioprosthetic valves preferred in patients who do not want to take long-term anticoagulation therapy 1
- The potential need for reoperation, with bioprosthetic valves having limited durability (10-15 years) compared to mechanical valves 1
Regular clinical follow-up should include echocardiography at 1 month, 1 year, and then annually after 5 years to monitor valve function. Patients should be educated about symptoms of valve dysfunction or heart failure that warrant immediate medical attention. The advantage of biologic valves is that they don't typically require long-term anticoagulation beyond the initial period, making them preferable for older patients, those with contraindications to anticoagulation, or women of childbearing age. However, they have limited durability compared to mechanical valves, necessitating potential reoperation, especially in younger patients.
From the Research
Biologic Valve Materials
- The choice of biologic valve material, either porcine or bovine, is a crucial decision in surgical valve replacement, with various studies comparing the outcomes of these two materials 2, 3, 4, 5.
- A study published in 2020 found that porcine bioprosthetic valves had better outcomes than bovine valves in terms of freedom from reoperation, non-structural valve deterioration, and heart failure 2.
- However, another study published in 2013 found that bovine valves had a superior complication profile and haemodynamic function compared to porcine valves 3.
- A more recent study published in 2021 found that porcine bioprosthetic valves were associated with improved long-term survival compared to bovine valves, but had a higher rate of reoperation 4.
- Another study published in 2022 found that there were no significant differences in clinical or echocardiographic postoperative outcomes between bovine and porcine bioprosthetic valves 5.
Post-Operative Management
- The post-operative management of patients with biologic valve replacements is crucial to ensure optimal outcomes, with factors such as anticoagulation therapy and follow-up care playing important roles 3, 4, 5.
- A study published in 1992 compared the biological properties of bovine pericardium and porcine aortic valve tissue, finding that bovine pericardium had superior intrinsic biological properties for prosthetic valve manufacture 6.
- The choice of biologic valve material and post-operative management strategy should be individualized to each patient, taking into account factors such as age, comorbidities, and lifestyle 2, 3, 4, 5.