Artificial Heart Valves

JAMA PATIENT PAGE Artificial Heart Valves

Artificial heart valves are used to replace heart valves that have become damaged with age or by certain diseases or congenital abnormalities.

Heart Valve Disease Artificial heart valves can be implanted when one’s own heart valves are not The 4 valves in the heart help the heart to function properly by en- working properly. Normally, the heart has four 1-way valves that work to regulate suring that blood is pumped in the correct direction when the heart blood flow through the heart, but they can become damaged, calcified, or dilated. contracts. Sometimes these valves can become tight, preventing Heart valves Types of valve disease (shown on aortic valve) HealthyStenosis Regurgitation blood from flowing forward. These valves can also leak, allowing Pulmonary

blood to flow backward. These problems are caused by wear and N Mitral

tear over time, certain diseases such as rheumatic heart disease, or OPE Aortic congenital abnormalities (conditions someone is born with). If left ED untreated, the faulty valves can cause life-threatening complica- Tricuspid

tions including heart failure, irregular heart rhythms, and stroke. To CLOS C avoid these problems, the damaged valves may need to be re- Disease may occur on any of the heart valves. paired or replaced. When performing valve replacement surgery, a Treatment can include open surgical or surgeon can use either a mechanical valve or a tissue valve. Types of artificial heart valves transcatheter artifical valve implantation. Mechanical valves are generally Tissue valves are generally suitable Mechanical Valves suitable for younger patients with for older patients with a shorter a longer life expectancy. life expectancy. The main advantage of a mechanical valve is durability; these valves • Require lifelong blood thinners • Blood thinners not required rarely require replacement and often last for the remainder of a pa- • Risk of blood clots • Risk of valve deterioration • More durable and repeat surgery tient’s life. A mechanical valve is well suited for young patients with • Less durable a long life expectancy, who may need the valve for many years. The main drawback of a mechanical valve is the tendency for blood clots Fabric ring to form on its metal surfaces, which can lead to serious complica- Titanium, Pig or cow tions including heart attack or stroke. Patients with a mechanical carbon leaflet tissue leaflet valve require lifelong blood-thinning medication, routine labora- tory tests, and lifestyle modifications such as limiting intense physi- This approach allows for faster recovery and quicker return to nor- cal activity. mal activities. The transcatheter approach was designed for older, sicker patients, who are expected to have a high risk of death or ma- Tissue Valves jor complications after open heart surgery. Transcatheter valve re- In contemporary practice, most tissue valves are constructed from placement may now be a reasonable approach in some intermedi- the pericardium (the sack that surrounds the heart) of pigs or cows. ate- and low-risk patients as well. There are limitations of Patients with a tissue valve do not require lifelong blood-thinning transcatheterprocedures.Onlytissuevalvescanbeusedwithatrans- medications, as blood clots are much less common. The main con- catheter approach. Their durability compared with surgically im- cern with a tissue valve is valve deterioration. Tissue valves are not planted valves is not yet known given that this technique is rela- as durable as mechanical valves, and patients who receive a tissue tively new. valve are more likely to require a subsequent operation to replace Patients with an artificial heart valve have increased risk of de- the valve when it fails. Tissue valves are generally recommended for veloping an infection of the valve (infective endocarditis) and patients older than 65 years or with life-limiting illnesses. should discuss planned dental procedures with their cardiologist and dentist to determine the need for antibiotics beforehand. Treatment Options Historically,valve replacement surgery has been performed through a chest incision (median sternotomy). Recently, a less invasive ap- FOR MORE INFORMATION proach has been used. Depending on which valve needs replace- Society of Thoracic Surgeons ment, an artificial valve can also be implanted using a transcatheter https://ctsurgerypatients.org/deciding-between-a-tissue-and-a- approach—inserting a catheter into the heart through the femoral mechanical-valve artery in the groin and implanting the valve through the catheter.

Authors: William C. Frankel, MD; Tom C. Nguyen, MD Conflict of Interest Disclosures: None reported. Correction: This article was corrected on July 1, 2021, for an author degree. Source: Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the Author Affiliations: Cleveland Clinic, Cleveland, Ohio (Frankel); University of management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77(4): California, San Francisco (Nguyen). e25-e197. doi:10.1016/j.jacc.2020.11.018

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