Aortic Valve.

[Edward Stepp]

I am a 59 years, with what I understand as a moderate to sevier leekage of the Aortic Valve. Test show no blockage of the coarnery artries. I have had an oblation to correct atrial febulation, with some success. while the left atriem still gives me some problem and I take Amiodrone for this. I believe it may help some. Other things are a partial bundel branch blockage, I believe it is left side.
It is recomended that I have the Aortic Valve replaced.
While I live in fear of this proccuder I have feath in my doctors, and will come to a decission to have the work done.
It has been recomended that I go with the mechanical valve. The St. Jude valve to be exact, Owing to my age. I dont care for this because of the medication need to keep down Thombroiss. I am told the valve is not repairable. I have studied as well as I can the diffrent valves and think I know the top brands, But I have been unable to get much information as to how well the tissue valves hold up. I am a active person even with this problem. I have had to slow down a lot. In reading your information, You replaced in 98 about 60% of your valves with the tissue valves.
Can you give any Information I can use to make this decision?
Thank you Ed Stepp Tn.

[CCF CARDIO MD - DLB]

Most surgeons would recommend a mechanical valve in your situation. At age 59, you probably would outlive your tissue valve and need another valve replacement in the future. THis may not be such a bad thing, assuming that you remain in good health even in your 70s. A homograft from a cadaver may be another option. However, if you have atrial fibrillation, you probably ought to be on blood thinners anyway, so the blood thinners needed for a mechanical valve would not be an additional consideration (coumadin is used for both indications).

[Gene Anspach]

I've been looking for information also. I am a 56 year old male who must have an aortic valve replacement due to aortic stenosis.  My heart is otherwise healthy and I have no contraindications for anti coagulation therapy.  I am having difficulty deciding between the homograft valve and the mechanical valve.  I have read your earlier responses and have read the Mayo Clinic Proceedings 73:231 (March 1998) which is the only large study I've seen with statistical data on homografts vs. mechanical valves.  However, it is missing some statistics which seem important to me.  I would like to know the risk or reoperation at 10yrs, 15yrs and 20yrs for each of these two options.  I would also like comparison statistics at 10yrs, 15yrs and 20yrs for risk of blood clot incidents and risk of infection.  How can one weigh the risk of lifetime anti-coagulation therapy with the mechanical valve against the risk of reoperation with the homograft.

Thanks for your help,

[CCF CARDIO MD - DLB]

The only problem with homografts is that there is not much in the way of long term data. Assuming you are a candidate for either procedure, it is difficult to say which would clearly be the better option for someone your age. While the risk of repeat surgery gets higher with age, the risk of anticoagulation also increases with age.

[Gene Anspach]

How safe is minimally invasive surgery for aortic valve replacement and is the risk with that procedure different for a mechanical valve or homograft?
Thanks again for the feedback

[CCF CARDIO MD - DLB]

Minimally invasive surgical replacement of the aortic valve is safe, assuming that you have a surgeon experienced with this technique. Homograft placement would be very tricky with a minimally invasive approach, as it involves aortic root surgery as well as valve surgery.