Prosthetic Heart Valves

Prosthetic Heart Valves is a topic covered in the Washington Manual of Medical Therapeutics.

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  • The choice of valve prosthesis depends on many factors including the patient, surgeon, cardiologist, and clinical scenario.
  • With improvements in bioprosthetic valves, the recommendation for a mechanical valve in patients <65 years of age is no longer as firm, and bioprosthetic valve use has increased in younger patients.
  • Mechanical valves
    • Ball-and-cage (Starr–Edwards): rarely, if ever, used today.
    • Bileaflet (i.e., St. Jude, Carbomedics): most commonly used.
    • Single tilting disk (i.e., Björk–Shiley, Medtronic Hall, Omnicarbon).
    • Advantages of mechanical valve: structurally stable, long-lasting, relatively hemodynamically efficient (particularly bileaflet).
    • Disadvantages of mechanical valve: need for anticoagulation/risk of bleeding, risk of thrombosis/embolism despite anticoagulation, severe hemodynamic compromise if disk thrombosis or immobility occurs (single tilting disk), risk of endocarditis, anticoagulation issues in women of child-bearing age.
  • Bioprosthetic valves
    • Porcine aortic valve tissue (i.e., Hancock, Carpentier-Edwards)
    • Bovine pericardial tissue (i.e., Carpentier-Edwards Perimount)
    • Advantages of bioprosthetic valve: no need for anticoagulation, low thromboembolism risk, low risk of catastrophic valve failure.
    • Disadvantages of bioprosthetic valve: structural valve deterioration, risk of endocarditis, still a small risk (approximately 0.04%–0.34% per year in recent meta-analysis) of thromboembolism without anticoagulation.1
    • Homograft (cadaveric): rarely used; most commonly used to replace the pulmonic valve.

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