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Mechanical vs Biological
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Mechanical vs Biological

I'm 61 with a long history of MVP. Recent years have brought increasing MVR - now moderate to severe. I'm largely asymptomatic (excluding mountain climbing), work out regualrly, and have a trim build. EF is 66% and the left ventricle has enlarged over time to 58mm. EKG is still normal. I take Atenolol, Lisinopril, and Aspitin daily.

My cardiologist advises a valvuloplasty within 3 to 6 mos. The surgeon said he's 80 - 85% certain he can repair the valve (via conventional surgery). This leading hospital and cardiology team does not yet offer minimally invasive valve surgery,  but another nearby does.

Should I pursue a second opinion? Should I pursue the minimally invasive option (which would require giving up all of my current docs if I go that route)?  If valve replacement becomes necessary, is a mechanical valve with lifetime Coumadin and low probability of a redo the better option?



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Thumperguy,

Thanks for the post.

The ACC guidelines recommend mitral valve surgery for mitral reurgitation with enlarged left ventricle (end-systolic dimension > 45mm).

There are not too many surgeons who do the mitral valve repair well.  If you choose not to seek a second opinion, make sure the surgeon doing the operation is very experienced.  Knowing how many of these that he does, his success rate, his mortality rate, etc. are things that may guide your decision to stay with him or go elsewhere.

You are in the gray area about whether or not to have a bioprosthetic valve versus a mechanical valve placed.  Most of us think that the new bioprosthetic valves will last longer than the older ones, but this is just what we think -- I can't prove it.

Hope that helps.



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