On Demand: Tissue or Mechanical? An Informed Discussion on Surgical Valve Selection-Presentation Slides

Presentation Slides

Pdf Summary

The 2025 MedAxiom webinar titled "Tissue or Mechanical? An Informed Discussion on Surgical Valve Selection," hosted by Edwards Lifesciences, addresses clinical decision-making for choosing between bioprosthetic (tissue) and mechanical heart valves, focusing on aortic and mitral valve replacements.

Key points include:

1. <strong>Guideline Recommendations:</strong> Both the 2025 European (ESC/EACTS) and 2020 American (ACC/AHA) guidelines support either mechanical or bioprosthetic valves, emphasizing individualized patient factors and shared decision-making rather than strict age cutoffs. Mechanical valves are often recommended in patients under 60-65 years (especially in Europe), while bioprosthetic valves are favored in those aged 70 and above. Between these ages, the choice balances bleeding risk from anticoagulation required by mechanical valves against the reoperation risk associated with bioprosthetic valves.

2. <strong>Mechanical vs Bioprosthetic Valve Tradeoffs:</strong> Mechanical valves offer greater durability but require lifelong anticoagulation, increasing bleeding and stroke risk, and lack a valve-in-valve minimally invasive option. Bioprosthetic valves avoid anticoagulation and allow future valve-in-valve procedures but have limited longevity and higher reoperation rates, particularly in younger patients.

3. <strong>Clinical Evidence:</strong> Studies show mechanical mitral valve replacement may have a long-term survival advantage up to 70 years but increased bleeding/stroke risks. Bioprosthetic mitral valves have lower stroke rates but higher reoperation mortality. Recent data reveals low reintervention rates (~4.5%) for bioprosthetic mitral valves over ~6 years, with durability improving due to advances in tissue preservation and valve-in-valve techniques.

4. <strong>Patient-Centered Management:</strong> Cardiologists play a critical role in lifelong monitoring, assessing valve function, anticoagulation compliance, and informing patients pre- and post-surgery. Shared decision-making is paramount, considering lifestyle, comorbidities, risk factors, and patient preferences.

5. <strong>Emerging Era:</strong> Innovations like tissue preservation technology and valve-in-valve interventions provide new options, enhancing the viability of bioprosthetic valves, especially for younger patients wishing to avoid anticoagulants.

In conclusion, no single valve type is universally best. Valve choice must be tailored through shared decisions informed by individual risk, lifestyle, and evolving clinical evidence to optimize long-term outcomes.

Keywords

Surgical valve selection

Mechanical heart valves

Bioprosthetic valves

Aortic valve replacement

Mitral valve replacement

Anticoagulation therapy

Valve-in-valve procedures

Cardiologist patient management

Valve durability

Shared decision-making