On Demand: Tissue or Mechanical? An Informed Discussion on Surgical Valve Selection-Webinar Recording

Video Transcription

Video Summary

The webinar, sponsored by Edwards Life Sciences, featured Drs. Nikhil Bhasi, Matthew Romano, and Patrick McCarthy discussing surgical valve selection with a focus on mechanical versus bioprosthetic valves for aortic and mitral valve replacements. Key points included that guidelines generally recommend mechanical valves for patients under 50-60 and bioprosthetic valves for those over 65-70, but there is a wide gray zone where shared decision-making is critical. Mechanical valves offer durability but require lifelong anticoagulation, presenting bleeding and stroke risks. Bioprosthetic valves avoid anticoagulation and allow valve-in-valve procedures but have limited durability, though advancements have improved longevity significantly. The importance of individualized care considering patient lifestyle, comorbidities, and preferences was emphasized, along with the role of left atrial appendage closure and surgical ablation for atrial fibrillation. The Ross procedure was noted as a specialized option for select younger patients. Discussions highlighted that many patients prefer to avoid anticoagulation despite mechanical valve survival benefits, and decision-making should go beyond age to include risks and quality of life. Advances in valve-in-valve technology and enhanced tissue preservation are shaping future management. Overall, the panel agreed on a nuanced, tailored approach focusing on lifetime management, patient education, and multidisciplinary collaboration to optimize outcomes.

Keywords

surgical valve selection

mechanical valves

bioprosthetic valves

aortic valve replacement

mitral valve replacement

anticoagulation

shared decision-making

Ross procedure

valve-in-valve technology