The heart valves are affected by a number of diseases which many a time lead to dysfunction of the valves and require replacement with a prosthetic (artificial) heart valve. The prosthetic heart valves are classified into mechanical (metallic) valves and bioprosthetic (tissue) valves. The mechanical valve is made up of metal alloys. Therefore, it needs lifelong blood thinners to avoid clot formation on the valve surface which could lead to malfunction of the valve. The major disadvantage of blood thinners is that it increases the chances of bleeding. Profuse bleeding after sustaining an injury or spontaneous bleeding in the brain and other vital organs can be life-threatening. The current generation mechanical valves are free from any structural deterioration and are unlikely to break in an individual’s lifetime. The bioprosthetic valve, on the other hand, does not require any blood thinners. It is made of animal tissue and chances of clot formation over a bioprosthetic valve is extremely low. However, the bioprosthetic valves are prone to structural deterioration. Depending upon the different techniques of manufacturing, these valves can last for 5 -20 years.
For an individual, choosing a heart valve primarily depends upon a combination of three factors:
- Age of the patient – Young individuals (<40 years) should prefer a mechanical valve in view of the longer life span they have. Older individuals should be offered bioprosthetic valve more so because chances of spontaneous bleeding are more in elderly and hence blood thinners are best avoided in them.
- Availability of medical facilities – Mechanical valves requiring blood thinners needs frequent and lifelong monitoring. Frequent consultation with a physician is required to measure and manage the level of these drugs in the blood. Therefore, the bioprosthetic valve should be offered to those individuals who live in places where medical facilities are not available and hence frequent monitoring is logistically difficult.
- Life expectancy – Patients requiring artificial heart valve often have serious coexisting diseases. Those patients who have short life expectancy should be offered bioprosthetic valves so that unnecessary blood thinner intake is avoided.
However, in an age where information is readily available to all patients, it is strongly suggested that patients read about the pros and cons of the available heart valves. They can then discuss their concerns with the treating Cardiac Surgeons before making a final decision.
Dr. Rachit Saxena is a Senior Consultant Cardiac and Aortic Surgery at Narayana Superspeciality Hospital in Gurugram
