Good morning family and welcome back to another week of Topic Tuesdays! This month our theme is the aortic valve in honor of Hearth Health Month. Today, we will follow up Purab and Sam's work talking about aortic valve anatomy and disease by discussing some options we have for valve replacement!
When deciding to undergo aortic valve replacement one of the most important decisions you and your doctor will make is whether you receive a mechanical or bioprosthetic (tissue) valve. Each of them offers unique benefits and limitations.
A mechanical valve is made out of a durable metallic material that makes it less susceptible to wear and tear over time. They are the longer-lasting valve, often pumping for 20-30 years before they start to exhibit signs of deterioration. For this reason, they are often the primary choice in younger patients.
The main drawback of mechanical valves is they have a higher risk of causing small blood clots as blood touches their hard surface. These clots are dangerous because they can lead to stroke or heart attacks if they lodge and block blood flow in the heart or brain. For this reason, anyone on a mechanical valve will be placed on blood thinner such as Coumadin (warfarin).
Alternatively, patients can consider bioprosthetic valves, which are made using tissue from either a cow (bovine ) or pig (porcine). These valves are coated with a non-immunogenic material so that your body will not "reject" it . They have a much lower risk of thrombosis and most patients do not have to be on life-long blood thinners their whole life like mechanical valves.
However, bioprosthetic valves are more susceptible to calcium buildup over time like your original aortic valve leading to premature structural valve deterioration. Their lifespan is estimated to be between 10 and 20 years, which may not be an issue in elderly patients. However, younger patients who undergo bioprosthetic valve replacement and “out-live” their valve will need a second valve replacement in their lifetime.
Notably, bioprosthetic valve are amenable to a technology called Valve-in-Valve transcatheter aortic valve, meaning your surgeon may be able to place a new valve inside the old one by doing a less invasive procedure through the groin instead of a second open-heart surgery. This will be discussed more in a future post later this month to stay tuned!
And that's it for today! Be sure to come the coming weeks as we learn more about surgical versus transcatheter aortic valve replacement! I hope you and your loved ones have an amazing week.
With regards,
AA
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