Biological Valve Replacement

Biological Valve Replacement

Overview

Valve replacement surgery is commonly done to correct defective heart valves that cause congestive heart failure (CHF) when the valve cannot be repaired. Replacing the valves is done with either a “tissue” valve or a mechanical (man-made) prosthesis. Tissue valves, also called biologic or bioprosthetic valves, are made from valves harvested from humans (such as an organ donor who died suddenly) or other animal (usually a pig). Tissue valves can also be built from the pericardium (the sac that covers the heart) or other tissues.

Tissue valves are advantageous for not requiring a blood thinner as a chronic anticoagulant to prevent emboli and strokes. However they may wear out and become calcified. This calcification causes stenosis and regurgitation which may require a repeat surgery for a new valve.

Indications

Most of the time, mitral valve prolapse does not require surgery. But if mitral regurgitation becomes serious, you may need surgery to replace or repair the mitral valve. The operation is big enough that you don’t want to undergo it unnecessarily, but important enough that you don’t want to wait until symptoms develop such as chest pain, shortness of breath, and fatigue. By that time, your left ventricle may have weakened so much that it won’t be able to regain normal function after your valve has been fixed.

For years, the standard approach involved opening the chest, stopping the heart, removing the failing valve, and replacing it with a new mechanical or biological (tissue) valve. In the 1970s, cardiac surgeons began devising ways to repair some leaky mitral valves rather than replace them. One approach involves cutting out the excess valve tissue, lining up the leaflets, and then inserting a ring around the valve to help it maintain a healthy shape. Another technique involves stitching together a section in the middle of the mitral valve. This creates a valve with two smaller regurgitation-resistant openings (one on either side of the stitches) instead of a single leaky opening.

Replacing the valve

If the leaflets of your mitral valve or the surrounding annulus are crusted with calcium deposits, or if the valve has been damaged by an infection of the lining of the heart (infective endocarditis), you may be better off having the valve replaced rather than repaired.

Choosing a replacement valve

Keep in mind that if you have mitral valve prolapse, chances are you’ll never need surgery. But if you do need surgery and decide to have the valve replaced, you’ll also need to decide what type of valve you want.  Replacement valves come in two main types, tissue and mechanical. Both have their advantages and disadvantages. Your doctor’s advice is important, but your personal preferences and situation should also be part of the decision. Here are some considerations:

  1. If you’re under age 65 and otherwise healthy, the chances are good that you’ll live at least another 20 years. That tips the balance toward a mechanical valve, which can last 20 to 30 years or more. If you’re over age 65 or have a life-shortening medical condition, a tissue valve may be more appropriate.
  2. Blood clots tend to form in mechanical valves, so if you choose one of these devices, you’ll need to take a blood-thinning (anticoagulant) drug such as warfarin (Coumadin) for life. Anticoagulants increase the risk of bleeding and can be bothersome to take. If you can’t take the drug or are at high risk for bleeding problems from it, then a tissue valve is a better option.
  3. Tissue valves work silently. Mechanical valves can make a quiet clicking noise that some people find bothersome, especially when they’re trying to fall asleep.

 

Other treatments:

Valvuloplasty

Mechanical Valve Replacement

Percutaneous Valve Replacement