TY - JOUR
T1 - Cardiac crossroads
T2 - Deciding between mechanical or bioprosthetic heart valve replacement
AU - Tillquist, Maggie N.
AU - Maddox, Thomas M.
PY - 2011
Y1 - 2011
N2 - Nearly 15 million people in the United States suffer from either aortic or mitral valvular disease. For patients with severe and symptomatic valvular heart disease, valve replacement surgery improves morbidity and mortality outcomes. In 2009, 90,000 valve replacement surgeries were performed in the United States. This review evaluates the advantages and disadvantages of mechanical and bioprosthetic prosthetic heart valves as well as the factors for consideration in deciding the appropriate valve type for an individual patient. Although many caveats exist, the general recommendation is for patients younger than 60 to 65 years to receive mechanical valves due to the valve's longer durability and for patients older than 60 to 65 years to receive a bioprosthetic valve to avoid complications with anticoagulants. Situations that warrant special consideration include patient co-morbidities, the need for anticoagulation, and the potential for pregnancy. Once these characteristics have been considered, patients' values, anxieties, and expectations for their lifestyle and quality of life should be incorporated into final valve selection. Decision aids can be useful in integrating preferences in the valve decision. Finally, future directions in valve technology, anticoagulation, and medical decisionmaking are discussed
AB - Nearly 15 million people in the United States suffer from either aortic or mitral valvular disease. For patients with severe and symptomatic valvular heart disease, valve replacement surgery improves morbidity and mortality outcomes. In 2009, 90,000 valve replacement surgeries were performed in the United States. This review evaluates the advantages and disadvantages of mechanical and bioprosthetic prosthetic heart valves as well as the factors for consideration in deciding the appropriate valve type for an individual patient. Although many caveats exist, the general recommendation is for patients younger than 60 to 65 years to receive mechanical valves due to the valve's longer durability and for patients older than 60 to 65 years to receive a bioprosthetic valve to avoid complications with anticoagulants. Situations that warrant special consideration include patient co-morbidities, the need for anticoagulation, and the potential for pregnancy. Once these characteristics have been considered, patients' values, anxieties, and expectations for their lifestyle and quality of life should be incorporated into final valve selection. Decision aids can be useful in integrating preferences in the valve decision. Finally, future directions in valve technology, anticoagulation, and medical decisionmaking are discussed
KW - Anticoagulant
KW - Patient preference
KW - Prosthetic heart valves
KW - Structural valve deterioration
KW - Valve type
UR - http://www.scopus.com/inward/record.url?scp=84860702570&partnerID=8YFLogxK
U2 - 10.2147/PPA.S16420
DO - 10.2147/PPA.S16420
M3 - Review article
C2 - 21448466
AN - SCOPUS:84860702570
SN - 1177-889X
VL - 5
SP - 91
EP - 99
JO - Patient Preference and Adherence
JF - Patient Preference and Adherence
ER -