Options for Aortic Valve Replacement

The type of valve you will receive during your aortic valve replacement should be based on a shared decision between you, your cardiologist, and your cardiac surgeon. It should be a free and informed decision made after careful consideration of many factors, including your medical history, lifestyle, risk of reoperation, and need for lifelong anticoagulation (blood thinner).1

Here are some heart valve replacement options your cardiologist and cardiac surgeon may have shared with you:

Mechanical Valve Icon
Tissue Valve Icon
Ross-Procedure-Icon
Homograft Valve Icon
TAVR Valve Icon
Comparison Icon

Mechanical
Valve

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Mechanical aortic heart valves are long-lasting valves made of durable materials. Most mechanical heart valves are bileaflet, meaning that they have two “leaflets” to control the blood flow to a single direction.2 While mechanical valves are often more durable, the risk for blood clot formation is higher, so lifelong use of blood thinner medication is necessary. This could be a limitation for athletes, patients with active lifestyles, or for women contemplating pregnancy in the future.

Tissue
Valve

Click to enlarge

Tissue (bioprosthetic) heart valves typically come from the heart of a pig (porcine) or a cow (bovine), and are treated and neutralized so that a human body will not reject them. Some aortic tissue valves are mounted on a frame or stent, while others are stentless. These valves typically do not require lifelong blood thinners, but have a limited durability. The younger you are at the time of surgery, the faster these valves wear out, increasing the risk of reoperation.1

The Ross
Procedure

Click to enlarge

The Ross Procedure uses your own healthy pulmonary valve (pulmonary autograft), which is a mirror image of a normal aortic valve, to replace your damaged aortic valve. A donated human pulmonary valve (pulmonary homograft/allograft) is then used to replace your pulmonary valve. The Ross Procedure does not require any blood thinners and offers a quality of life and restores long-term life expectancy similar to the general population and people who have not undergone aortic valve replacement.3,4 An important point to remember is that it should be performed by a surgeon familiar with this technique.5

Homograft/
Allograft
Valve

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Aortic homografts/allografts are aortic valves from a human donor. This type of valve is typically used in patients with endocarditis (bacterial infection of heart valve). An allograft is recommended over tissue and mechanical valves in an endocarditis patient, if the infection is extensive and destructive.6 Similar to bioprosthetic valves, aortic allografts wear out more quickly in younger patients, increasing the risk of early reoperation.1

TAVR/
TAVI

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In this minimally invasive procedure, the old, damaged aortic valve is not removed. The TAVR tissue (bioprosthetic) valve is deployed into the old aortic valve using a large catheter. TAVR is most commonly used in elderly, high-risk patients who cannot undergo surgical aortic valve replacement.7

Compare
Options

Table 1: Advantages and Disadvantages of Aortic Valve Replacement (AVR) Options

AVR Options- able

MLENG1301.000 (2018-08)

References:

  1. Nishimura R et al., Circulation 2017;135:e1159-95.
  2. Rajashekar P J Pract Cardiovasc Sci 2015;1:289-93.
  3. Mazine A et al., Circulation 2016;134(8):576-85.
  4. El Hamamsy I et al., The Lancet 2010;376(9740):524-31.
  5. Ouzounian M et al., J Thorac Cardiovasc Surg 2017;154:778-82.
  6. Pettersson GB et al., J Thorac Cardiovasc Surg 2017;153:1241-58.
  7. Leon M et al., N Engl J Med 2016;374(17):1609-20.
  8. van Geldorp M et al., J Thorac Cardiovasc Surg. 2009;137:881-6.
  9. Pibarot P et al., Am J Cardiol 2000;86(9):982-8.
  10. ACC/AHA Practice Guidelines, J Amer Coll Cardiol 2006;48:1-148.