Aortic/Mitral Valve Replacement

[Sherrie T.]

My 63 yr old mother needs to have an AVR and possible MVR.  She is in general good health.  Lipidema, hypothroid, no CAD good EF. She has beed given choices of mechanical, pig and also human. (I'm unsure if this is her pulmonic or a cadaver, I think a cadaver.)  It seems difficult to choose any of these.  They all seem to have their share of pros and cons.  Could you please give me some insight and me more info. on the pros and cons of a cadaver valve.

[Cleveland Clinic, MD]

Thank you for your question. There are two main options for aortic valve replacement: mechanical and tissue.  Examples of mechanical valves are St.Jude, Star-Edwards and Medtronic-Hall.  The advantage of the mechanical valve is its long life (usually longer than the person receiving it).  The disadvantage is the need for life-long coumadin. There are no long term complications from taking coumadin other than the bleeding risks.



Tissue valves are made from pig or cow hearts and last about 5- 10 years.  The main advantage is not having to take coumadin.  Aortic homografts are tissue valves from cadavers and also do not require anticoagulation and may last longer than other types of tissue valves.  No one really knows how long but it is probably more than 10 - 15 years.  The chief disadvantage of the homograft is availability.  



The Ross procedure transplants the patients own pulmonic valve to the aortic position and places a tissue valve in the pulmonic position.  We have stopped doing this procedure at the Cleveland Clinic due to poor long-term outcomes with the pulmonic valve.



As you can see each option has its pros and cons.  Ultimately the choice is between you and your doctor.