How to choose which heart valve to have. Mechanical or tissue?

[Victorian42]

How do you decide which heart valve to have. Mechanical or tissue?

[Hanibil]

Hi I had a mechanical aortic valve in 2005 at the Wellington hospital in London my Surgeon recommended this as I was 48 and it would last a life time, where the alternatives would require replacing in approximately 10 years. Who would want to go through all that trauma again if they didn’t have to. I have to say it was definitely the write decision I haven’t had one single issue with it. Yes you will have to take warfarin but again have had no issues. If you require to know anything else please don’t hesitate to contact me.

[Rhinos67]

Hi, I was guided by my surgeon. The deciding factor was my anxiety around hospitals. The thought of having OHS again in 10 years would have been too much for me to cope with so he advised mechanical. I had my surgery at the end of April last year and so far so good.

If you aren't already a member of UK Aortic and Heart Defects Pre and Post surgery group in Facebook then I can highly recommend. I got so much advice and reassurance in the lead up to my surgery and during recovery

😊

Joanne

[Willytell]

Hi , I had the latest generation cow valve 16 weeks ago at Papworth which has been developed to last for approximately 25yrs and designed so when needing replacing a new AV can be put in place by going through the groin this second valve has a 10 year life span this means I don’t need to take Warfarin which not always but can be problematic ( I work in a Pharmacy ) all I take is 75mg aspirin . Listen to your surgeon and take his / her advice , wishing you well .

[MikeThePike in reply to Willytell]

It's always good to do personal research and find out what the latest developments are. We assume that our doctors keep up to date but they don't always. Best wishes to all.

[DinoCat in reply to Willytell]

My experience (age 69; replacement aortic valve is Edwards Inspiris; minimally invasive surgery mid-Oct) was pretty similar to yours. Two separate Consultant surgeons assessed me & both independently suggested this particular (biological) valve. I was told (more conservatively) a c15 yr anticipated valve lifespan, but as it's still comparatively new nobody knows for definite yet! However, if a second replacement is needed, and OH surgery is then not advisable, the back-up is a TAVI/TAVR, through groin as you say. Surgeon said that the Inspiris valve is an ideal substrate for a future TAVI, if needed. With this particular valve one can avoid using Warfarine, which both surgeons considered would be a significant lifestyle benefit. Instead, I was put on Apixaban as an anti-coagulant, & if all is OK after 3 months (i.e., normal sinus rhythm & no AF) even that could be stopped? I am now at that review point & if your case is the same it would be helpful to what you were advised about ongoing anti-coagulant?

[3MSF in reply to Willytell]

Hi - I’m in a similar position with AVR last March and was told possible 30 year lifespan of the valve (as my typical resting heart rate is around 54 bpm). If I may, do you take anything to protect your stomach from the 75mg aspirin? My friend doesn’t, but my doctor says I should yet I’m sure the Lansoprazole are ruining every day I have with a sickly feeling stomach for most of the day, every day. 🙁

[Willytell in reply to 3MSF]

hi , the dispersible 75mg Aspirin is such a small dose and as it is dispersed it’s very unlikely to cause any problems , the other type of 75mg Aspirin which isn’t dispersible has a coating on the tablet to protect your stomach while it is dissolved and absorbed , so no I don’t take anything . I was at the time of my operation a very healthy and fit 64 year old but with severe aortic regurgitation with no other problems and now I’m very fortunate that all I have to take is the Aspirin and 1.25mg Bisoprolol . I was able to go back to work after 9 weeks . As it’s been said before we are all different and must be guided by our doctors ect but it’s never wrong to ask them why or if there’s an alternative ,

[3MSF in reply to Willytell]

Many thanks for the quick and detailed response - much appreciated, and food for thought! 🙂👍🙏

[RichardUK2]

Hi Victorian42,

It is a difficult decision and I struggled to decide too. Age is certainly an important factor and I would have changed my decision if I was older.

I’m 39 and decided to have the Ross Procedure as this is the only solution which gives you an aortic valve replacement with your own live tissue. There are benefits to this but there are risks of reoperation with the Ross, if you’re lucky you won’t have surgery again, if unlucky you will need two valve replacements, possibly at different times.

My second choice, given my age, would have been an Inspiris Resilia valve which is a modern prosthetic valve based on animal tissue. The reason for me would be to avoid blood thinners, a personal choice. There are claims that these valves last longer than the typical 10 years or so depending on your age (the younger you are the faster they wear out). However it’s early and there isn’t sufficient evidence that any of these valves can, on average at least, last 15 or 20 years. They may do, they may not. Surgeons have different opinions on them.

The mechanical valve should give you the longest time without reoperation, potentially never again. The downside is of course the blood thinners which carry an increased annual risk of other problems. Also may not be ideal if you have other health problems. That said, you have less risk of surgery again.

I came to the conclusion that all the options have their ups and downs and the choice is personal and circumstantial.

Hope this helps and happy to answer any questions. I have my Ross Procedure Saturday.

Richard x

[DinoCat in reply to RichardUK2]

That's a good summary! See my separate reply to Willytell. All the very best for your Ross Procedure

[Robfromwales]

anyone know if Edwards Inspiria Resilience is available as an option in all main aortic repair hospital settings? And are there ( other than the main tissue v mechanical issues) any additional factors that need to be bourne in mind with this type ( other than the easier replacement via the groin )?

[Jocastina]

One important factor is which valve do you need replaced? Aortic, mitral, tricuspid or pulmonary? Different options are available depending on which one. Your age is also a factor. I had a mechanical mitral valve replacement 18 months ago when aged 51.

[BicuspidBloke]

I had my Aortic Valve Replacement in August, aged 50 and via Open Heart Surgery. The surgeon clearly wanted me to have a mechanical valve but as I'm quite active with running, cycling, gym and the odd obstacle race I was leaning towards the tissue valve. The decider was how clumsy I am - I'm always bumping into things, tripping around the house and falling whilst running. I don't bleed much externally but I figured internal bleeding & bruises would be a very real problem on warfarin. I went for the Inspiris Resilia tissue valve with the hope that it lasts 12 to 15 years (I appreciate my active lifestyle will wear it out slightly quicker) and hopefully by then I will be able to have any second operation through a minimally invasive approach.

[Victorian42]

Thanks everyone certainly alot to think about, some of the options I didn't even know existed. I have a bicuspid aortic valve with severe stenosis. Being advised to go with mechanical as small valve and not suitable for TAVR on second surgery if have a tissue they think. Warfarin certainly concerns me, also read it can make your hair fall out? This has all been such a shock I'm 58 and just thought was getting older with the breathlessness. Always been active.

[Cat04]

At age 65 I was given the choice of tissue or mechanical valve but when I mentioned that when I had previously struggled keeping a stable INR (sometimes having to visit the inr clinic 3 times a week) the surgeon categorically said tissue. This leaves the TAVI/TAVR options for the future. I also have aflutter/afib so need to continue taking apixaban anyway.

Now post op+12 days AVR, LAAe clip, PVI with LOM divided. I had a largish valve implanted to accommodate the future options.

[3MSF]

Hi - I had the Inspiris Resilia as advised by the surgeon at Glenfield hospital. He said it could be good for 30 years (I was 57 at the time and needed my bicuspid valve replacing) and is designed to be replaced in the future if and when needed by the less invasive groin route. The tissue used is now even more resilient to calcial build-up and bacteria I believe. I also didn’t want Warfarin, and who knows what they’ll come up with in the next 5 years. Very happy with the Resilia choice for my new aortic valve, and who’s going to challenge the suggestion of a well respected cardiac surgeon? 🙂