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Help with valve selection for AVR.

Hello,

My sister, age 26, unmarried, residing in Bangalore, India needs to undergo an surgery for AVR. She is suffereing from congenital valve disease. We are confused with the selection of valve between tissue valve and mechanical valve given her child bearing age. Can you please help us with following questions?
a) What is the average lifespan of tissue valve?
b) What is the best tissue valve? The options I am aware of are porcine, bovine, homograft.
c) What are the complications involved in redo surgery?
d) What are the precautions to be taken with mechanical valve.
e) She also has mild MR. Doctors suggest she might need a replacement/ repair for that valve as well. Considering this does the choice of tissue/ mechanical valve changes?

I am attaching reports herewith for more details.
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Avatar universal
Tissue valves tend to last fewer years in young people like your sister than they do in the usual valve patient, who is older.  It's my impression, although I don't know if there has been any research done on this, that the valve lifetime is not as predictable in a young person as in someone older, so that makes the decision even more complicated than it might be.  She won't necessarily know how long a tissue valve will last her.  

If your sister wants to have children, the tissue valve is a better choice, but she may need to go ahead and have her children quickly, in case the valve life turns out to be only a few years.  The only way I am aware that a woman with a mechanical valve might be able to carry a pregnancy to term is by taking daily heparin injections for anticoagulation purposes.  Most people with a mechanical heart valve take warfarin tablets, but warfarin is contraindicated in pregnancy.  Heparin is supposed to be safe for the baby, but there is no oral heparin; it has to be injected.  

If I were in your sister's place, and I could live with the thought of not having children, I believe I would go ahead and get a mechanical valve.  If your sister gets a tissue valve at her age, then even if it does last her 10 to 15 years, she will require at least one more open-heart surgery, and OHS is a heavy-duty surgery.  There is a small but real percentage of people who do not live through open-heart surgery.  FWIW, I've been through two valve replacement surgeries myself, and I never want to go through another one.  

I'm female, but I was past child-bearing age when I had the first surgery, so having children was not a concern for me, but I think it all comes down to that:  how badly does your sister want to have children?  Because if I knew I wanted children, I would get the tissue valve.  Then when the tissue valve had to be replaced, that's when I would get the mechanical valve.  Best wishes to your sister as she makes this decision and goes through her surgery.
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11548417 tn?1506080564
A tissue valve will normally last only for 10-15 years. Mechanical valves are generally appropriate for a majority of patients 65 years old and younger

The choice for a 26 year old person would normally be not so difficult.

There is however a new procedure evolving very quickly with which it is possible to repair valves via a catheter (TAVI procedure). It is to be expected that surgeons will be able to repair a defect prosthetic tissue valve through such a procedure within 15 years.

Mild MR in itself is not a problem, only if it becomes moderate or severe it needs attention. Often the regurgitation does not increase for many years. Why does the doctor expect worsening of the regurgitation?
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