Aortic regurgitation surgery valve selection: Difference between revisions
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==Advanatges of A Mechanical Valve== | ==Advanatges of A Mechanical Valve== | ||
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. | 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<ref name="pmid1992318">{{cite journal| author=Bloomfield P, Wheatley DJ, Prescott RJ, Miller HC| title=Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 9 | pages= 573-9 | pmid=1992318 | doi=10.1056/NEJM199102283240901 | pmc= | url= }} </ref><ref name="pmid11028464">{{cite journal| author=Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH| title=Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. | journal=J Am Coll Cardiol | year= 2000 | volume= 36 | issue= 4 | pages= 1152-8 | pmid=11028464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11028464 }} </ref>. 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== | ==Advantages of A Bioprosthetic Valve== | ||
[[Biological]] valves do not require anticoagulation, but they tend to fail over time <ref name="pmid8469251">{{cite journal| author=Hammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S| title=A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 18 | pages= 1289-96 | pmid=8469251 | doi=10.1056/NEJM199305063281801 | pmc= | url= }} </ref><ref name="pmid11028464">{{cite journal| author=Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH| title=Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. | journal=J Am Coll Cardiol | year= 2000 | volume= 36 | issue= 4 | pages= 1152-8 | pmid=11028464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11028464 }} </ref>. Patients with a biological valve may need to have the valve replaced in 10 to 15 years. | Bioprosthetic valves are made of human or animal tissue.[[Biological]] valves do not require anticoagulation, but they tend to fail over time <ref name="pmid8469251">{{cite journal| author=Hammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S| title=A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 18 | pages= 1289-96 | pmid=8469251 | doi=10.1056/NEJM199305063281801 | pmc= | url= }} </ref><ref name="pmid11028464">{{cite journal| author=Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH| title=Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. | journal=J Am Coll Cardiol | year= 2000 | volume= 36 | issue= 4 | pages= 1152-8 | pmid=11028464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11028464 }} </ref>. 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 <ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172 }} </ref><ref name="pmid17259184">{{cite journal| author=Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G et al.| title=Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. | journal=Eur Heart J | year= 2007 | volume= 28 | issue= 2 | pages= 230-68 | pmid=17259184 | doi=10.1093/eurheartj/ehl428 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17259184 }} </ref>: | |||
*If the patient is under 65 years of age and do 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 has already a mechanical valve in the mitral or tricuspid position (need anticoagulation). | |||
*If the patient has active prosthetic valve endocarditis; the valve should be replaced. | |||
*If the patient has contraindications to anticoagulation therapy regardless his or her age; then a bioprosthetic valve is indicated. | |||
*In case of small oartic root; mechanical valve is indicated as there is a risk of annular enlargement in such patient if bioprosthetic valve is used. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 13:15, 15 April 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prior to surgery, the surgeon and patient must make a choice as to whether a mechanical or bioprosthetic valve should be inserted. A bioprosthetic valve may be a better choice in an older individual who is at risk of bleeding and whose life expectancy is less than that of the valve (10-15 years).
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[1][2]. 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 [3][2]. 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 [4][5]:
- If the patient is under 65 years of age and do 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 has already a mechanical valve in the mitral or tricuspid position (need anticoagulation).
- If the patient has active prosthetic valve endocarditis; the valve should be replaced.
- If the patient has contraindications to anticoagulation therapy regardless his or her age; then a bioprosthetic valve is indicated.
- In case of small oartic root; mechanical valve is indicated as there is a risk of annular enlargement in such patient if bioprosthetic valve is used.
References
- ↑ Bloomfield P, Wheatley DJ, Prescott RJ, Miller HC (1991). "Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses". N Engl J Med. 324 (9): 573–9. doi:10.1056/NEJM199102283240901. PMID 1992318.
- ↑ 2.0 2.1 Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH (2000). "Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial". J Am Coll Cardiol. 36 (4): 1152–8. PMID 11028464.
- ↑ Hammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S (1993). "A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease". N Engl J Med. 328 (18): 1289–96. doi:10.1056/NEJM199305063281801. PMID 8469251.
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.
- ↑ Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G; et al. (2007). "Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology". Eur Heart J. 28 (2): 230–68. doi:10.1093/eurheartj/ehl428. PMID 17259184.