Aortic Valve Replacement

Aortic valves that have become severely blocked (aortic stenosis) are typically degenerated and hardened such that repair is unlikely to result in a good long-term outcome. These valves are generally replaced. Furthermore, if infection or other processes have destroyed the valve leaflets, the valve usually needs to be replaced. Otherwise, if the valve leaflets are normal but the valve leaks because of the presence of an aortic aneurysm, we favor techniques to save the patient's valve (valve sparing aortic valve replacement).

This will result in the best long-term valve function and prevent the need for taking lifelong blood thinners. Aortic valve surgery is performed with a minimally invasive approach by the team at the University of Maryland.

UM Cardiac surgeons are leaders in aortic valve bypass, which offers several advantages over conventional aortic valve replacement.

Valve Replacement Options

If your valve needs replacement, this can be accomplished with either:

  • A biologic (tissue) valve made of tissue from human cadaver donor, pig (porcine) valve tissue, or cow (bovine) tissue.
  • A mechanical valve

Advantage of Tissue Valves

Tissue valve replacement means that the patient will not have to take blood thinners. Long-term use of blood thinner medicine carries a risk of serious bleeding complications and therefore it may not be the best option for someone young and active. Tissue valves perform extremely well, especially with the latest generation valves treated with the newest anti-mineralization and preservation techniques. Tissue valves last longer now, but about 10% after 10 years and 20% after 15 years may need repeat valve surgery. (Read patient success story).

Stentless tissue valves and homografts have the advantage of excellent long-term performance. These valves behave physiologically like a normal aortic valve relieving a blockage across the aortic valve.* These valves also appear to last the longest of all the tissue valves, with a chance for a repeat surgery 10 years later of only 10%. This possibility of repeat surgery needs to be balanced against the need for lifelong blood-thinning medication in the case of mechanical valves.

(*Homografts from a human cadaver donor and stentless tissue grafts from a pig are a normal aortic valve removed with its own support structure in place. When implanted, they have minimal residual gradient across the valve and the best hemodynamic performance for the patient).

Advantages of Mechanical Valves

Like tissue valves, mechanical valves have evolved over the last 40 years. Current generation mechanical valves are dependable, offer excellent performance and have low complication risks. However, lifelong blood thinning with coumadin is required after implantation of a mechanical valve. This carries a 1% risk of bleeding and thromboembolization per year. Home monitoring of blood thinning will now make the therapy more convenient.


For more information or to schedule a consult, please call 410-328-5842.

This page was last updated: February 4, 2014

         
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