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Heart Disease (Expert Forum)
hear valve replacement
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hear valve replacement
by Lary-Bishov, May 13, 1998 12:00AM
I'm a 48 year old male with a congenital heart defect - aortic stenosis.
When I was 14 I had open heart surgery to help correct the problem.
I am now experiencing problems such as shortness of breath, etc.
My cardiologist said I am a good candidate for aortic valve replacement.
My question is what type of valves are used in the procedure and what
are the pro's and con's of the different types of valves?
Doctor's Answer
by CCF Cardio MD - MTR, May 13, 1998 12:00AM
_
Dear Larry, thank you for your question. There are many different options
when it comes to aortic valve replacement. The decision on what kind of
valve to use is made by the patient, his/her cardiologist, and a cardiothoracic
surgeon. Issues involved in making that decision include the patient's age,
the risks of long-term anticoagulation, and lifestyle factors. There are three
main types of aortic valve replacements: mechanical, bioprosthetic (porcine),
or homografts. Mechanical valves are made of durable metallic/polymer
substances and function much the may native valves do. The most commonly used
mechancial valves have two discs which open when the left ventricle contracts
to eject blood and which then close after the blood has been ejected. Mechanical
valves are very durable but require life long anticoagulation because the valve
surfaces are prone to developing blood clots. Bioprosthetic valves are made from
pig valves and pericardial tissue. The valve leaflets are bioprosthetic and are
supported by a prosthetic annulus which provides support to suture the device into
the heart muscle. Anticoagulation is not required for bioprosthetic valves but
these valves degenerate over a period of 10-15 years and often need to be
replaced by that point. Aortic homografts are a relatively new option.
Homografts are cryopreserved, intact aortic valves obtained from cadavers. This
type of valve most closely resembles the native aortic valve but the surgery is
more technically demanding because the coronary arteries have to be reattached
to the aorta during homograft placement, unlike the two other types of valves.
Long-term results are not yet available for homografts but many physicians believe
these valves will have a limited lifespan, like bioprosthetic valves. There was
a good review article recently (ME Staab, Mayo Clinc Proceedings, March 1998,
Vol. 73, pages 231-238) on aortic homografts that you could obtain from any
medical library.
In your case, I think a mechanical valve or an aortic valve homograft would
be the best option, depending on your feelings about long-term anticoagulation.
Aortic valve replacements are often done via a minimally invasive approach but
since you've previously had open heart surgery, that may not be possible. The
decision on what type of valve is best for you eventually rests with you, your
cardiologist, and a cardiothoracic surgeon. I hope you find this information
useful.
Information provided in the heart forum is for general purposes only.
Specific diagnoses and therapies can only be provided by your physician.
