From the Guidelines
Mechanical heart valves have a significant advantage over bioprosthetic valves in terms of durability and survival rates, particularly in patients under 60 years of age.
Key Advantages of Mechanical Valves
- Lower risk of primary valve failure: Studies have shown that mechanical valves have a lower risk of primary valve failure compared to bioprosthetic valves, especially in patients under 65 years of age 1.
- Improved survival rates: Mechanical valves have been associated with improved survival rates in patients under 60 years of age, with some studies showing a significant reduction in mortality rates compared to bioprosthetic valves 1.
- Better valve hemodynamics: Mechanical valves have been shown to have better valve hemodynamics, which may contribute to their improved survival rates 1.
Important Considerations
- Anticoagulation therapy: Mechanical valves require lifelong anticoagulation therapy, which can increase the risk of bleeding complications 1.
- Patient preference and lifestyle: The choice between a mechanical and bioprosthetic valve should be made on a case-by-case basis, taking into account the patient's lifestyle, preferences, and individual risk factors 1.
- Age and durability: Bioprosthetic valves may be a better option for older patients or those with a shorter life expectancy, as they have a lower risk of anticoagulation-related bleeding and do not require long-term anticoagulation therapy 1.
From the Research
Advantages of Mechanical Heart Valves
- Mechanical heart valves provide superior durability and freedom from re-operation compared to bioprosthetic valves 2
- Mechanical valves are associated with a long-term survival benefit for patients between 50 and 70 years old 3
- Mechanical valves can provide a significantly better prognosis in patients with infective endocarditis, with lower risks of recurrence and reoperation 4
Comparison of Mechanical and Bioprosthetic Valves
- Bioprosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, despite issues with durability 5
- Mechanical valves have lower transvalvular pressure gradients compared to bioprosthetic valves 6
- The need for reoperation is higher in bioprosthetic valve groups, while the rate of major bleedings is higher in mechanical valve groups 6
Clinical Implications
- Mechanical valves are recommended for patients less than 60 years old and those who are older than 65 but maintained on anticoagulation for reasons other than their valvular disease 2
- Bioprosthetic valves should be placed in patients who are greater than 65 years old or those patients who have a postoperative life expectancy of less than 10 years 2
- Valve choice in patients between the ages of 60 to 70 is not dictated by guidelines and is less clear, with patient preference playing a larger role than their age range 2