Re: aortic valve replacement

Posted By CCF CARDIO MD - MTR on January 01, 1999 at 18:04:23:

In Reply to: aortic valve replacement posted by john on December 29, 1998 at 15:22:57:






I am a runner and a swimmer and 47 years old.  In mid january
I am to have my aortic valve replaced.  I am trying to decide
whether to go with a stentless porcine valve or a homograft.
Both types of valves seem to last 10-15 years.  Is the procedure
for both the same?  If you were having this operation, which would
go with?



  ________
Dear John, thank you for your question.  I've attached a paragraph on aortic valve replacement options below.
Aortic Valve Replacment Options:
There are four basic options for aortic valve replacement (AVR).  First, a mechanical AVR involves a prosthetic valve (usually a St. Jude's or Carbomedics valve) that has excellent long-term durability but requires coumadin - a blood thinner.  Coumadin can be harmful to fetal development so women who expect to become pregnant after an AVR should investigate options that do not require coumadin.  Second, a bioprosthetic AVR is made from porcine tissue and doesn't require coumadin.  However, a bioprosthetic valve only lasts 10-15 years so it's not appropriate for a young person.  Third, an aortic valve homograft is a cryopreserved cadaveric aortic valve that is self-contained in the overlapping aortic tissues and is inserted as a whole conduit.  The native coronary arteries are reimplanted just above the valve.  While homografts have only been used for 10-15 years, results are good and coumadin is not needed.  However, there are unanswered questions regarding long-term durability with homografts.  Fourth, there is a unique form of AVR called the Ross Procedure that involves switching the native pulmonic valve to the aortic position and replacing the pulmonic valve with an aortic homograft.  This surgery is very technically demanding and should only be done by a surgeon with good experience since there is a high rate of perioperative and postpoerative complications.  The benefit of a successful procedure is, however, no need for coumadin and probably the most durable aortic valve prosthesis that doesn't require coumadin.   There is a website for the Ross Procedure and the URL is http://www1.primenet.com/~carym/.  Finally, AVR can be performed via a minimally invasive approach with a 4-5 inch incision and postoperative pain and recuperation are reduced.  Our surgeons at Cleveland Clinic have pioneered minimally invasive valve replacement, so you may want to consider coming to Cleveland for an evaluation.  
If you want to completely avoid blood thinners after your AVR, then I recommend that you choose an aortic valve homograft since this prosthesis is somewhat more durable that a porcine AVR.  However, it's unlikely that a homograft will last > 20 years.  If you would only like to have one open heart surgery and you are ready to take blood thinners indefinitely, then I recommend a mechanical AVR.   After you have  a chance to ponder these options, I think you should speak with your cardiologist before making a final decision.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.