Aortic insufficiency surgery valve selection

Overview
Prior to surgery, the surgeon and patient must make a choice as to whether a mechanical or bioprosthetic valve should be inserted.

Advanatges of A Mechanical Valve
Mechanical valves are made of man-made (synthetic) materials, such as a metal like titanium. Mechanical heart valves do not fail often. They last from 12 to 20 years. However, blood clots develop on them. If a blood clot forms, the patient may have a stroke. Anticoagulation with warfarin will be required which can be associated with bleeding.

Advantages of A Bioprosthetic Valve
Bioprosthetic valves are made of human or animal tissue.Biological valves do not require anticoagulation, but they tend to fail over time. Patients with a biological valve may need to have the valve replaced in 10 to 15 years.

Selecting A Mechanical Verssus a Bioprosthetic Valve
The 2006 American College of Cardiology/American Heart Association (ACC/AHA) recommendations for the choice of aortic valve :


 * If the patient is under 65 years of age and does not have a contraindication to anticoagulation then a mechanical valve is preferred.
 * If the patient is ≥65 years of age and does not have risk factors for thromboembolism, then a bioprosthetic valve is reasonable
 * If the patient already has a mechanical valve in the mitral or tricuspid position and already requires anticoagulation, then a mechical valve is preferred
 * If the patient has active prosthetic valve endocarditis, then the valve should be replaced
 * If the patient has contraindications to anticoagulation therapy regardless his or her age, then a bioprosthetic valve is indicated
 * If the oartic root is small then a mechanical valve is indicated as there is a risk of aortic annular enlargement if a bioprosthetic valve is used