From the Guidelines
There are several types of aortic valve replacements available, including mechanical valves, biological or tissue valves, and transcatheter aortic valve replacements (TAVR), with the choice between them depending on patient age, comorbidities, contraindications to anticoagulation, and lifestyle considerations. The main categories of aortic valve replacements are:
- Mechanical valves, made of durable materials like carbon and metal alloys, which typically last a lifetime but require lifelong anticoagulation therapy with warfarin to prevent blood clots 1
- Biological valves, which include those made from bovine (cow) pericardium, porcine (pig) valves, or human donor valves (homografts), and do not require long-term anticoagulation but typically last 10-15 years before potentially needing replacement 1
- Transcatheter aortic valve replacements (TAVR), a minimally invasive procedure where a biological valve is delivered via catheter, usually through the femoral artery, and is particularly beneficial for high-risk surgical patients 1
- Autograft implantation (Ross Procedure), which represents a viable option for younger and middle-aged adults 1 The choice between these options depends on various factors, including patient age, comorbidities, contraindications to anticoagulation, and lifestyle considerations, with younger patients often receiving mechanical valves due to their durability, while elderly patients typically receive biological valves to avoid anticoagulation complications 1. Recovery time varies significantly, with TAVR patients often discharged within days compared to traditional open-heart surgery requiring weeks of recovery 1. According to the most recent study 1, accurate measurements of the aortic annulus and root are crucial for guiding the choice of valve prosthesis and reducing TAVR-related complications.
From the Research
Types of Aortic Valve Replacements
The main types of aortic valve replacements are:
- Mechanical valves: These valves are made of metal or other materials and are designed to last for many years 2, 3, 4, 5, 6.
- Bioprosthetic valves: These valves are made from animal tissue or human donor tissue and are designed to be more similar to a natural valve 2, 3, 4, 5, 6.
Key Differences Between Mechanical and Bioprosthetic Valves
Some key differences between mechanical and bioprosthetic valves include:
- Durability: Mechanical valves are generally more durable and can last for 20-30 years or more, while bioprosthetic valves may need to be replaced after 10-15 years 2, 3, 5.
- Anticoagulation: Mechanical valves require patients to take anticoagulant medication for the rest of their lives to prevent blood clots, while bioprosthetic valves do not require anticoagulation 2, 3, 4, 5.
- Reoperation: Bioprosthetic valves are more likely to require reoperation due to valve degeneration or other complications 2, 3, 5.
- Bleeding risk: Bioprosthetic valves have a lower risk of bleeding complications compared to mechanical valves 3, 5.
Patient Factors to Consider
When choosing between a mechanical and bioprosthetic valve, patient factors to consider include:
- Age: Patients under 50 years old may be recommended for mechanical valves, while patients over 70 years old may be recommended for bioprosthetic valves 2.
- Life expectancy: Patients with a shorter life expectancy may be recommended for bioprosthetic valves, while patients with a longer life expectancy may be recommended for mechanical valves 4.
- Lifestyle: Patients who are active or have a high risk of bleeding may be recommended for bioprosthetic valves, while patients who are sedentary or have a low risk of bleeding may be recommended for mechanical valves 4, 5.