This surgery is performed with extracorporeal circulation and general anesthesia in the operating room. The procedure consists of replacing the aortic valve with a mechanical or biological prosthesis, a choice that depends on the patient.
Mechanical prostheses are placed in younger patients with a life expectancy of more than 25 years and require life-long anticoagulant therapy.
Biological prostheses have the great advantage of not needing anticoagulation, but they last approximately 20 years. However, there are alternative methods for aortic valve replacement of a biological valve in case of early degeneration.
Mechanical valves vs biological valves:
The life expectancy of the world population has increased in recent decades. This growth is due to better food, access to health care, and prevention through vaccines and research and development of medicines that prevent the evolution of fatal diseases. If before valve diseases were mainly caused by rheumatic diseases, today we see that degeneration is the main reason and is an inherent consequence of the aging process of the population.
Surgery to replace defective valves has also evolved. Currently, the replacement of the mitral and aortic valves is performed through minimally invasive procedures, made from incisions of a few centimeters, which provide rapid recovery, reduce the possibility of complications, and minimize the risk of bleeding and infections.
There are two types of heart valves that are used in replacement surgery:
Mechanical: Made of titanium or carbon.
Biological: Made from human, bovine, porcine and equine pericardium tissues.
The choice of the type of valve to be used follows medical criteria, particularities of the patient’s condition, and guidelines based on statistical and scientific studies of large specialized medical associations, such as the European Society of Cardiology and the American College of Cardiology. Even so, this topic is still controversial between doctors and patients.
According to the European Society of Cardiology, age, life expectancy and valve type will determine the choice between biological and mechanical. The Society recommends the adoption of the following guidelines:
Use of mechanical valves:
1. Aortic Valve Replacement: Young and adult patients up to 60 years of age.
2. Mitral Valve Replacement: Young and adult patients up to 65 years.
Use of biological valves:
1. Aortic Valve Replacement: Patients aged 61 years or older
2. Mitral Valve Replacement: Patients aged 66 years or older
These indications take into account the peculiarities of valve types and concomitant treatments. Each type of valve has advantages and disadvantages, namely:
Advantages of mechanical valves: They are more durable and do not require a second surgery for replacement
Disadvantages: It is necessary to take anticoagulants for life and have periodic blood tests to monitor the level of clotting
Advantages of biological valves: No need to use any accessory medication
Disadvantages: Shorter durability and possibility of performing a second surgery for replacement, after 15 – 20 years of use.
In the same way that surgical techniques have evolved, the design, technique and materials of mechanical valves have also advanced. The advance in the research of new materials and synthetic fabrics could also revolutionize the manufacture of prostheses. The important thing is to follow your doctor’s guidelines so that you have the best quality of life.
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