Cardiac crossroads: Deciding between mechanical or bioprosthetic heart valve replacement

School of Medicine, University of Colorado Denver, Denver, CO, USA.
Patient Preference and Adherence (Impact Factor: 1.68). 02/2011; 5:91-9. DOI: 10.2147/PPA.S16420
Source: PubMed


Nearly 15 million people in the United States suffer from either aortic or mitral valvular disease. For patients with severe and symptomatic valvular heart disease, valve replacement surgery improves morbidity and mortality outcomes. In 2009, 90,000 valve replacement surgeries were performed in the United States. This review evaluates the advantages and disadvantages of mechanical and bioprosthetic prosthetic heart valves as well as the factors for consideration in deciding the appropriate valve type for an individual patient. Although many caveats exist, the general recommendation is for patients younger than 60 to 65 years to receive mechanical valves due to the valve's longer durability and for patients older than 60 to 65 years to receive a bioprosthetic valve to avoid complications with anticoagulants. Situations that warrant special consideration include patient co-morbidities, the need for anticoagulation, and the potential for pregnancy. Once these characteristics have been considered, patients' values, anxieties, and expectations for their lifestyle and quality of life should be incorporated into final valve selection. Decision aids can be useful in integrating preferences in the valve decision. Finally, future directions in valve technology, anticoagulation, and medical decision-making are discussed.

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Available from: Thomas M Maddox
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    • "For most patients with severe aortic valve disease, aortic valve replacement is the treatment of choice. For the majority of patients two options exist: mechanical or bioprosthetic aortic valve replacement [1]. The decision for a particular prosthetic valve type is ideally driven by scientific evidence on patient outcome after implantation with different valve substitutes, the patient’s clinical state and circumstances, and informed patient preferences. "
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    ABSTRACT: Aims Assess and compare among Dutch cardiothoracic surgeons and cardiologists: opinion on (1) patient involvement, (2) conveying risk in aortic valve selection, and (3) aortic valve preferences. Methods and results A survey among 117 cardiothoracic surgeons and cardiologists was conducted. Group responses were compared using the Mann–Whitney U test. Most respondents agreed that patients should be involved in decision-making, with surgeons leaning more toward patient involvement (always: 83 % versus 50 % respectively; p < 0.01) than cardiologists. Most respondents found that ideally doctors and patients should decide together, with cardiologists leaning more toward taking the lead compared with surgeons (p < 0.01). Major risks of the therapeutic options were usually discussed with patients, and less common complications to a lesser extent. A wide variation in valve preference was noted with cardiologists leaning more toward mechanical prostheses, while surgeons more often preferred bioprostheses (p < 0.05). Conclusion Patient involvement and conveying risk in aortic valve selection is considered important by cardiologists and cardiothoracic surgeons. The medical profession influences attitude with regard to aortic valve selection and patient involvement, and preference for a valve substitute. The variation in valve preference suggests that in most patients both valve types are suitable and aortic valve selection may benefit from evidence-based informed shared decision-making.
    Full-text · Article · Jun 2014 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    • "In addition, GA is toxic and inhibits the repopulation of cells after implantation [23]. Both mechanical and bioprosthetic valves share another disadvantage: they cannot grow and remodel, which may necessitate sequential surgeries in pediatric patients [24]. Nevertheless, the current generation of bioprosthetic pericardial valves are adequate substitutes for the majority of elderly patients as they typically do not require anticoagulation and their durability is usually sufficient for the lifespan of this population. "
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    ABSTRACT: Tissue engineered heart valves offer a promising alternative for the replacement of diseased heart valves avoiding the limitations faced with currently available bioprosthetic and mechanical heart valves. In the paradigm of tissue engineering, a three-dimensional platform - the so-called scaffold - is essential for cell proliferation, growth, and differentiation as well as the ultimate generation of a functional tissue. A foundation for success in heart valve tissue engineering is recapitulation of the complex design and diverse mechanical properties of a native valve. This article reviews technological details of the scaffolds that have been applied to date in heart valve tissue engineering research.
    Full-text · Article · Mar 2014 · Acta biomaterialia
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    ABSTRACT: In this study, structure and biomechanical properties of freeze-dried decellularized porcine pulmonary heart valves were investigated. Heart valves were dissected from porcine hearts. The tissues were decellularized and separated in three groups: (1) without lyoprotectant, (2) with 5% sucrose, and (3) with a mixture of 2.5% sucrose and 2.5% hydroxyl ethylene starch (HES), and then underwent freeze-drying. Freeze-drying in the absence of lyoprotectants caused an overall more disintegrated appearance of the histological architecture of the porcine valves, especially between the fibrosa and the ventricularis layers. Freeze-dried tissues with lyoprotectants have a looser network of collagen and elastic fibers with bigger pore sizes. Tissue freeze-dried in the absence of lyoprotecants had the largest pore sizes, whereas the tissue freeze-dried in the presence of protectants showed pores of intermediate sizes between the decellularized tissue and the unprotected freeze-dried samples. Tissue freeze-dried with sucrose alone displayed less porosity than tissue freeze-dried with the sucrose/HES mixture, whereas no significant differences in biomechanical properties were observed. Decellularization decreased the elastic modulus of artery tissue. The elastic modulus of freeze-dried tissue without protectants resembled that of decellularized tissue. The elastic modulus values of freeze-dried tissue stabilized by lyoprotectants were greater than those of decellularized tissue, but similar to those of native tissue.
    Full-text · Article · Feb 2012 · Tissue Engineering Part C Methods
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