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Artificial heart valves are used to replace heart valves that have become damaged with age or by certain diseases or congenital abnormalities.
Heart Valve Disease
The 4 valves in the heart help the heart to function properly by ensuring that blood is pumped in the correct direction when the heart contracts. Sometimes these valves can become tight, preventing blood from flowing forward. These valves can also leak, allowing blood to flow backward. These problems are caused by wear and tear over time, certain diseases such as rheumatic heart disease, or congenital abnormalities (conditions someone is born with). If left untreated, the faulty valves can cause life-threatening complications including heart failure, irregular heart rhythms, and stroke. To avoid these problems, the damaged valves may need to be repaired or replaced. When performing valve replacement surgery, a surgeon can use either a mechanical valve or a tissue valve.
The main advantage of a mechanical valve is durability; these valves rarely require replacement and often last for the remainder of a patient’s life. A mechanical valve is well suited for young patients with a long life expectancy, who may need the valve for many years. The main drawback of a mechanical valve is the tendency for blood clots to form on its metal surfaces, which can lead to serious complications including heart attack or stroke. Patients with a mechanical valve require lifelong blood-thinning medication, routine laboratory tests, and lifestyle modifications such as limiting intense physical activity.
In contemporary practice, most tissue valves are constructed from the pericardium (the sack that surrounds the heart) of pigs or cows. Patients with a tissue valve do not require lifelong blood-thinning medications, as blood clots are much less common. The main concern with a tissue valve is valve deterioration. Tissue valves are not as durable as mechanical valves, and patients who receive a tissue valve are more likely to require a subsequent operation to replace the valve when it fails. Tissue valves are generally recommended for patients older than 65 years or with life-limiting illnesses.
Historically, valve replacement surgery has been performed through a chest incision (median sternotomy). Recently, a less invasive approach has been used. Depending on which valve needs replacement, an artificial valve can also be implanted using a transcatheter approach—inserting a catheter into the heart through the femoral artery in the groin and implanting the valve through the catheter. This approach allows for faster recovery and quicker return to normal activities. The transcatheter approach was designed for older, sicker patients, who are expected to have a high risk of death or major complications after open heart surgery. Transcatheter valve replacement may now be a reasonable approach in some intermediate- and low-risk patients as well. There are limitations of transcatheter procedures. Only tissue valves can be used with a transcatheter approach. Their durability compared with surgically implanted valves is not yet known given that this technique is relatively new.
Patients with an artificial heart valve have increased risk of developing an infection of the valve (infective endocarditis) and should discuss planned dental procedures with their cardiologist and dentist to determine the need for antibiotics beforehand.
Society of Thoracic Surgeonshttps://ctsurgerypatients.org/deciding-between-a-tissue-and-a-mechanical-valve
Correction: This article was corrected on July 1, 2021, for an author degree.
Conflict of Interest Disclosures: None reported.
Source: Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77(4):e25-e197. doi:10.1016/j.jacc.2020.11.018
Frankel WC, Nguyen TC. Artificial Heart Valves. JAMA. 2021;325(24):2512–2513. doi:10.1001/jama.2020.19936
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