Heart Valve Replacement: Which Type Is Best for You?

How mechanical and biological valves differ
Heart Valve Replacement: Which Type Is Best for You?

If you have a faulty heart valve, your doctor may prescribe medication or surgically repair it. But sometimes, the valve needs to be replaced altogether.

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“It’s important for people to know that you still have options if valve repair isn’t possible,” says cardiovascular and thoracic surgeon Lars Svensson, MD, PhD, Chairman of Cleveland Clinic’s Miller Family Heart & Vascular Institute. Aortic valve repair has excellent long-term results in appropriate patients with leaking valves.

There are two main types of heart replacement valves to choose from — mechanical and biological.

Which one will work best for you? It depends on your situation, Dr. Svensson says.

The choice of valve type is influenced by:

  • Your age.
  • Whether or not you have other diseases.
  • Your own preference.

“You can decide if you want to have a biological valve that will likely need replacement in time If you are younger or a mechanical one that is less likely to fail, but will require other life-long protective anticoagulation,” Dr. Svensson says.

Here’s what you need to know about replacement valves, as well as pros and cons.

Mechanical valve: Pros and cons

Mechanical valves are made of carbon and metal and make a slight clicking sound that patients may hear — although some do not hear it at all. Their design mimics the leaflets of a natural valve. They are the type that surgeons most often implant in young patients and typically can last between 20 and 30 years without requiring additional surgeries.

Dr. Svensson says mechanical valves are best for those who:

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  • Are younger than age 65 who want to avoid a second surgery when they are older.
  • Have overactive parathyroid glands (affecting blood calcium levels).

The downside is that mechanical valves can have blood clots form on them. To reduce this risk, you’ll need to take a blood thinner for the rest of your life, which increases the risk of bleeding.

Ongoing research is focused on finding alternatives to current blood thinners, Dr. Svensson says. Newer, carbon-based mechanical valves may reduce the need for a daily blood thinner as well, he says.

Biological valve: Pros and cons

Biological valves, also known as bioprosthetic valves, come from cows or pigs in most cases. Doctors use human donor valves only rarely.

Typically, biological valves last between 10 and 15 years, so you may require another replacement surgery at some point.

They don’t come with a higher risk of blood clots, so you most likely won’t need to take a blood thinner.

Biological valves are best, Dr. Svensson says, for those who:

  • Are over age 65.
  • Have kidney disease.
  • Are pregnant.
  • Cannot take Coumadin®.
  • Have a job or recreational sport or hobby that increases the risk for bleeding or injury.

Types of biological valves include:

Bovine (cow). This type is not an actual valve. Rather, it comes from tissue surrounding the cow’s heart. The tissue is strong and flexible, and treating it prior to surgery prepares it so that your body can accept it without any negative immune response. Cow valves can develop calcification that can narrow the valve opening and decrease blood flow over time.

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Porcine (pig). These valves are actual pig heart valves, and they’re also treated to avoid rejection from your body. They perform similarly to cow valves, but they are less likely to calcify but are more likely to tear over time.

Human. This is the least common replacement valve. It is generally reserved for patients who have a disease that affects their valve, such as infective endocarditis. Human valve replacements are associated with severe calcification of the donor aortic wall over time, which increases the potential need for subsequent surgery.

Biological valves and pregnancy

Biological valves are best for you if you’re pregnant because of safety during pregnancy, but it’s likely they’ll need to be exchanged later, Dr. Svensson says.

On the other hand, using a mechanical valve could elevate your risk during pregnancy, requiring you to take blood thinners. But research shows that blood thinners can harm a fetus.

“If a woman is pregnant, our advice is to use a biological valve,” Dr. Svensson says. “It’s a good idea for her child-bearing years, and then she can make a decision later — if the biological one fails — to switch to mechanical.”

If you need a replacement valve, work closely with your doctor. They can consider your preferences and health history as you carefully weigh the options.

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