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[Patient-adapted valve selection: biological vs. mechanical heart valve replacement in aortic valve diseases]
S Brose1, R Autschbach, T Rauch
1Klinik für Thorax-, Herz- und Gefässchirurgie Klinikum RWTH Aachen Pauwelstr. 30 52074 Aachen, Germany. Sbrose@klinikum.rwth-aachen.de
Insights
Choosing between mechanical and biological heart valve prostheses involves balancing durability against anticoagulation risks. For patients over 65, biological options are often recommended due to bleeding risks with anticoagulation.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Medicine
Background:
- Aortic valve replacement is a common cardiac surgery procedure.
- Prosthetic options include mechanical and biological heart valves (xenografts, homografts).
- Selection requires balancing biological valve durability against mechanical valve anticoagulation risks.
Purpose of the Study:
- To review indications for aortic valve stenosis and regurgitation surgery.
- To compare advantages and disadvantages of mechanical versus biological prostheses.
- To discuss alternative techniques like aortic valve reconstruction.
Main Methods:
- Literature review of studies from the last two years.
- Analysis of mechanical and biological heart valve prostheses (xenograft, homograft, ROSS procedure).
- Inclusion of rarely used techniques such as aortic valve reconstruction.
Main Results:
- Biological prostheses offer 12-15 years of durability.
- Anticoagulation for mechanical valves increases bleeding risk with age.
- Biological prostheses are recommended for patients aged 65 and older.
Conclusions:
- The choice of prosthesis depends on patient age and risk factors.
- Biological valves are favored for older patients due to anticoagulation risks.
- Further research is needed on stentless biological prostheses to potentially lower the age recommendation.
Abstract:
Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.