Tissue Valve Is the Preferred Option for Patients Aged 60 and Older

Abstract

A 60-year-old man presents to your clinic. He has symptomatic severe Aortic stenosis with a bicuspid valve diagnosed by transthoracic echocardiogram. No coronary disease was found on cardiac catheterization. What would be the valve choice in this patient? To answer this question, we need to explore the myths surrounding heart valve prostheses, which include the following: 1. Patients with mechanical valves survive longer. 2. Patients with bioprostheses will never require anticoagulation. 3. Patients on warfarin therapy should get mechanical valve. 4. Patients with mechanical valve should receive mechanical valve at the time of reoperation. 5. Reoperation and structural valve deterioration (SVD) rates are the same. 6. Mechanical valves have better hemodynamics. Response by Suri and Schaff on p 1371 Recently, there has been a monumental shift toward the use of bioprosthetic valves. From the Society of Thoracic Surgeons (STS) database, applications of mechanical valves have decreased from 49.9% in 1997 to 20.5% in 2006, whereas bioprosthetic valve usage increased from 43.6% in 1997 to 78.4% in the aortic position.1 A similar trend was documented in the mitral position; from the STS database, usage of mechanical valve has decreased from 68% in 2000 to 37% in 2007.2 Classic teaching recommends mechanical valve for younger patients because of its durability at the expense of lifetime anticoagulation. In contrast, bioprostheses will free patients from anticoagulation but exposes them to the risk of SVD, which increases with time. As the trend grows toward increased use of bioprostheses, age limit for bioprosthetic valve use versus mechanical valve is intensely debated. According to the most updated American College of Cardiology/American Heart Association (ACC/AHA) guideline from 2008, patient age is no longer on the Class I recommendation for aortic valve replacements (AVR). There is class IIa recommendation to use mechanical valve in patients aged <65 years who do not have a …