Who needs valve replacement surgery
Before we dive into the specifics of it, first let us try to understand a few things, such as
1) What are heart valves
2) What is the function of the heart valves
3) Who needs a valve replacement surgery
4) What are the types of valves that are available
1) What are heart valves?
Heart valves are flap like structures within the heart that act as a one way door There are 4 valves in the heart
a) Tricuspid valve
b) Pulmonary valve
c) Mitral valve
d) Aortic valve
2) What is the function of the valves?
Thes valves are responsible for controlling the flow of blood in the right direction within the heart and preventing its back flow.
3) Who needs a valve replacement?
Those patients whose valve is diseased due to various reasons and does not function properly leading to varied symptoms.
a) Valves can get stenosed(narrowing) which prevents adequate forward flow
of blood
b) Valves can be regurgitant, which means the “door” does not close properly
leading to back flow of the blood
4) What are the different types of valves?
a) Mechanical valve
b) Bioprosthetic valve(made from animal tissue)
Both of these valves have certain advantages and disadvantages. Mechanical valve
Advantages: longer durability and cheaper Disadvantage: needs lifelong anticoagulation
Bioprosthetic valve
Advantages: does not need anticoagulation
Disadvantages: valves can degenerate faster, especially in younger patients and they are more expensive
The American college of cardiology(ACC)/ American heart asscociation(AHA) have come out with certain guidelines to choose the appropriate valves based of these factors
Let us now dive into the factors that influences the decision in choosing the right valve
1) Age of the patient
2) Contraindication for anticoagulation(cannot take blood thinner medicines)
3) Patient activity level
4) Future pregnancy plans
1) Age of the patient
<50yrs: mechanical valve if no contraindication for anticoagulation
50-65yrs: either mechanical or bioprosthetic valve based on patient factors
>65yrs: bioprosthetic valve
l Mechanical valve are durable but require anticoagulation
l Biopsothetic valve does not require anticoagulation but deteriorates faster
especially in younger patients.
l Shorter life expectancy in older people favors the use of bioprosthetic valves
2) Contraindications for anticoagulation
Patients who have a history of bleeding tendency, inability to monitor INR, in such patients bioprosthetic valves are adviced to reduce the risk of bleeding as it avoids anticoagulation.
3) Patient activity level
Patients who are in profession that demands strenous physical activity(eg: sports), chances of injury and bleeding is higher if they are on anticoagulation. Hence bioprosthetic valve is recommended.
4) Future pregnancy plans
Anticoagulation therapy can affect the fertility and cause developmental anomaly in the fetus. Ladies who wish to get pregnant, the recommendation is bioprothetic valve.
Key takeaways
1) Mechanical valve
l Great durability
l Requires life long anticoagulation
l Preferred in younger and low bleeding risk patients
2) Bioprosthetic valve
l Doe not need long term anticoagulation
l Higher risk of degenartion
l Preferred in older patients or when anticoagulation is contraindicated
The take home message is, that the patient and family should discuss with their surgeon the various risks and benefits of each type of valve and make an informed decision accordingly.
Dr. Ashwin Kumar
MBBS | MS (Gen Surgery) | MCh (Cardio-Thoracic Surgery)
Consultant – Cardiothoracic Surgeon
