It's Topic Tuesday!- Biological vs. Mechanical Valve
- Sathyap Pallapothula
- 8 hours ago
- 2 min read
Hello Aortic Hope family! I hope that you are having a great start to your week and are ready for today's discussion on aortic valve considerations for isolated aortic valve surgery. For many people facing isolated aortic valve surgery, one of the biggest decisions is choosing between a mechanical valve and a bioprosthetic (tissue) valve. Both options are safe and effective, but they differ in how they perform over time and in the lifestyle adjustments they require. Understanding these differences—especially the trade-off between lifelong anticoagulation and the risk of structural valve deterioration (SVD)—can help patients feel more confident as they plan for surgery.
Mechanical Valves
Mechanical valves are made from durable materials like carbon and metal. They are built to last a lifetime, making repeat surgery far less likely. Their main drawback is the need for lifelong anticoagulation, typically with warfarin. This medication prevents blood clots from forming on the valve but requires periodic blood tests and careful management. Some patients also notice a faint “clicking” sound from the valve, though many grow used to it.
Anticoagulation is safe for most patients, but it does come with an increased bleeding risk. Daily life remains very normal for the vast majority of individuals, including participation in exercise and travel, as long as INR levels are monitored and kept within range.
Bioprosthetic (Tissue) Valves
Tissue valves, made from bovine or porcine tissue, more closely resemble a natural valve in how they feel and function. The biggest advantage is that long-term anticoagulation is not required, which appeals to many patients. However, tissue valves naturally wear out over time. This process—known as structural valve deterioration—can lead to the valve narrowing, leaking, or stiffening.
Durability depends heavily on age. Younger patients may see a tissue valve last only 5–10 years, while older adults often enjoy 15–20 years or more of good function. When tissue valves do fail, many can now be replaced with a less invasive TAVR valve-in-valve procedure, reducing the need for another open-heart surgery.
Making the Decision
There is no single “best” valve choice. Younger patients who want to avoid future surgeries often lean toward mechanical valves, while older adults or those hoping to avoid anticoagulation often prefer tissue valves. Your medical history, lifestyle, plans for pregnancy, and personal preferences all play an important role.
It’s helpful to talk with your surgeon about how each option might look over the course of your life. Ask about expected durability, the realities of anticoagulation, and whether TAVR could be used in the future if a tissue valve wears out.
Overall, isolated aortic valve surgery is a significant milestone, and understanding the differences between mechanical and bioprosthetic valves can make the process feel less overwhelming!
Thank you so much for joining me today, and I hope to see you again!
-Sathya Pallapothula