Leading expert in cardiac surgery and minimally invasive heart valve procedures, Dr. Lawrence Cohn, MD, explains the critical decision-making process between tissue and mechanical heart valve replacement, emphasizing how patient age, lifestyle goals, and willingness to manage lifelong anticoagulation therapy determine the optimal choice for long-term health and quality of life.
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Tissue vs. Mechanical Heart Valve Replacement: A Patient's Guide to Choosing the Right Valve
Jump To Section
- Tissue vs. Mechanical Valves: Core Differences
- Age-Based Recommendations and Patient Choice
- How Lifestyle Impacts the Valve Choice Decision
- Risks of Lifelong Anticoagulation Therapy
- Understanding the Risks of Repeat Surgery
- Making the Final Decision: A Collaborative Process
Tissue vs. Mechanical Valves: Core Differences
Heart valve replacement surgery presents patients with two primary options. Mechanical heart valves are constructed from artificial, durable materials designed to last a lifetime. Tissue heart valves, also known as bioprosthetic valves, are typically made from carefully treated cow tissue (bovine) or pig tissue (porcine). The fundamental trade-off is between durability and lifestyle. As Dr. Lawrence Cohn, MD, clarifies, a mechanical valve necessitates daily blood-thinning medication, while a tissue valve will likely require a repeat operation in the future.
Age-Based Recommendations and Patient Choice
Formal guidelines suggest that patients over 60 or 65 years of age are best suited for a tissue heart valve replacement. Conversely, patients younger than 60 are often recommended a mechanical valve. However, Dr. Lawrence Cohn, MD, notes that in practice, this is a free choice made by the patient after understanding the pros and cons. Surprisingly, over 70% of patients in the United States opt for an animal tissue valve, regardless of their age, prioritizing freedom from anticoagulation over long-term durability.
How Lifestyle Impacts the Valve Choice Decision
Lifestyle is frequently the deciding factor for many patients considering heart valve replacement. Younger, active individuals often choose a tissue valve to continue participating in sports like skiing, hockey, football, or soccer. These high-impact activities carry a significant risk of injury and bleeding for patients on blood-thinning medications like warfarin. The desire for an unrestricted, active life without the constant concern about bleeding risks leads many to accept the probability of a future second surgery.
Risks of Lifelong Anticoagulation Therapy
The primary drawback of a mechanical heart valve is the absolute requirement for lifelong anticoagulation therapy. Patients must take daily medication, such as warfarin (Coumadin), and undergo frequent blood tests to monitor their levels. This regimen manages the constant risk of blood clots forming on the mechanical valve but introduces a new risk of serious bleeding complications. Dr. Lawrence Cohn, MD, also points out that some patients have other medical conditions that prohibit the safe use of these anticoagulant drugs.
Understanding the Risks of Repeat Surgery
A tissue valve replacement typically lasts between 12 to 15 years before it begins to degenerate, calcify, and develop stenosis, necessitating a second operation. Dr. Anton Titov, MD, asked Dr. Cohn about the risks associated with this repeat procedure. In expert hands, the risks of a second heart valve replacement surgery can be similar to those of the first operation. The key, according to Dr. Cohn, is for the patient not to wait too long once the valve begins to fail, ensuring they are in the best possible condition for the reoperation.
Making the Final Decision: A Collaborative Process
The choice between a tissue and mechanical heart valve is a profoundly personal one that must be made collaboratively between the patient, their family, and their cardiac team. It involves a careful evaluation of the patient's age, overall health, life goals, and risk tolerance. Dr. Anton Titov, MD, highlights the value of a second opinion to confirm the diagnosis and ensure the chosen treatment path is the best one. This decision balances the burden of daily medication against the acceptance of future surgery, ultimately aiming for the best long-term quality of life.
Full Transcript
Dr. Anton Titov, MD: Should a patient prefer a heart valve replacement with a tissue valve? A mechanical heart valve may be better for some patients. A pig heart valve is better for elderly patients. Sometimes it is necessary to replace a heart valve.
Tissue or mechanical valve replacement? In elderly patients, porcine aortic valve replacement is preferred. In younger patients, aortic valve replacement with a pig valve is preferred. Younger patients may want to play sports.
How do you compare the choice of a tissue or mechanical valve for a heart valve replacement operation? Today, aortic valve replacement options include animal tissue valves and mechanical valves.
The pig valve vs. mechanical valve decision depends on the willingness and ability of the patient to take oral anticoagulants. The patient needs to take blood-thinning medications for the rest of their life. A repeat surgical operation in 15 years is also required in heart valve replacement with a tissue pig valve.
Lifestyle modification after heart valve replacement requires careful evaluation of life goals and lifestyle requirements.
Dr. Lawrence Cohn, MD: Choose a tissue valve to continue active sports. You can do skiing, football, soccer, and traveling with a tissue heart valve.
Dr. Anton Titov, MD: Sometimes a patient has to have surgery to replace a heart valve. How do you decide between a tissue heart valve and a mechanical heart valve?
How can elderly patients make a decision about replacement of a heart valve?
Dr. Lawrence Cohn, MD: There are only two kinds of replacement heart valves. The mechanical heart valve is made of artificial materials. There is also a tissue heart valve, which is made of cow tissue or pig tissue.
The current recommendation is that everyone over 60 or 65 years of age should have a tissue heart valve as a replacement heart valve. Everybody younger than 60 or 65 should have a mechanical valve as a replacement valve.
The problem with a mechanical heart valve is that a patient has to take blood-thinning medication every day for the rest of their life. Patients also have to do blood tests frequently. A lot of patients do not like to do that.
Some patients also have diseases when anti-coagulation with medicines is prohibited. Anticoagulation medications are warfarin or Coumadin.
More than 70% of patients in the United States choose an animal tissue heart valve. This decision is independent of the age of the patient. Then patients do not have to take blood-thinning medication.
Patients also have to understand that they will require a repeat operation in 12 to 15 years' time. Patients will need to replace the animal tissue valve with a new valve.
But elderly patients often receive animal tissue valve replacement because elderly patients do not tolerate anti-coagulation well. Blood-thinning medications, warfarin or Coumadin, can also be contraindicated because of other diseases in elderly patients.
So in the United States, the choice of a mechanical heart valve or an animal tissue heart valve is the free choice of the patient. The patient knows the advantages and disadvantages of both replacement heart valves.
But a lot of younger patients choose an animal tissue replacement heart valve because they want to ski or play hockey. Patients cannot play those sports if they take blood-thinning medications. Coumadin has a high risk of bleeding.
Patients know that they can have an animal tissue valve replacement, but then they will have to have another heart surgery sooner than if they had a mechanical replacement heart valve. A lot of decisions of patients depend on their lifestyle.
This is how patients choose a mechanical heart valve or a pig heart valve for replacement.
Dr. Anton Titov, MD: What are the risks of repeat heart surgery in 12 to 15 years if a patient has an animal tissue heart valve? Are the risks similar to the risks of the first operation?
Dr. Lawrence Cohn, MD: In our hands, the risks of repeat heart valve replacement surgery are similar to the risks of the patient's first valve replacement surgery. In some other hands of surgeons, the risks of a repeat operation could be higher.
But the patient should not wait too long before the second animal tissue valve replacement operation. Sometimes the replaced heart valve of the patients becomes calcified and develops stenosis; then patients should prepare to have repeat surgery to replace the heart valve a second time.
Dr. Anton Titov, MD: Tissue or mechanical valve replacement? The patient’s age and lifestyle are determining factors. A mechanical valve has anticoagulation necessity. A pig valve has a repeat operation risk.