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[26] [27] [13] Since the risk of blood clots forming is higher with mechanical valves than with tissue valves, patients with mechanical heart valves are required to take anticoagulant (blood-thinning) drugs, such as warfarin, long-life, making them more prone to bleeding (1% per year). [13]
The valve is excised 4–5 mm from the annulus, leaving intact the attached chordae unless they are calcified or otherwise diseased. The valve is replaced by a mechanical or bioprosthetic valve. The replacement valve is sewn into the annulus with interrupted or horizontal mattress sutures with the pledgets on the atrial side. [20]
Valve sparing aortic root replacement (VSARR) is an alternative procedure to the composite aortic valve graft (CAGVR, Bentall procedure). A notable benefit of VSARR is the reduced need for anticoagulation, as the patient's own aortic valve is spared and does not need to be replaced with a mechanical or bioprosthetic valve. [11]
Tissue valves are less durable than mechanical valves, typically lasting 10–20 years. [20] This means that people with bioprosthetic valves have a higher incidence of requiring another aortic valve replacement in their lifetime. [16] Bioprosthetic valves tend to deteriorate more quickly in younger patients. [21]
Valve replacement surgery is the replacement of one or more of the heart valves with either an artificial heart valve or a bioprosthesis (homograft from human tissue or xenograft e.g. from pig). It is an alternative to valve repair .
Repair is a more recent alternative to replacement; in many instances replacement will be the only realistic option because of severe destruction of the valve. [6] While replacement of the aortic valve is a safe and reproducible procedure it may still be associated with the long-term occurrence of so-called valve-related complications.
The rationale for age-based recommendations is that surgical aortic valve replacements are known to be durable long-term (average of durability of 20 years), so people with longer life expectancy would be at higher risk if TAVI durability is worse than surgery. [9]
[54] [55] [56] However, surgical aortic valve replacement is well-studied, and generally has a good and well-established longer-term prognosis. [57] A diseased aortic valve is most commonly replaced using a surgical procedure with either a mechanical or a tissue valve.