Should I get a biological or mechanical heart valve replacement?

My mother is 72 years old and has severe mitral valve regurgitation. She is recommended for a valve replacement. What type of valve replacement should she receive? Will she have to take medication for the rest of her life? (Minh Anh, Ho Chi Minh City)

Reply:

The heart has four chambers (left atrium, right atrium, left ventricle, right ventricle) and four valves (mitral valve, tricuspid valve, aortic valve, pulmonary valve). Heart valves allow blood to flow in one direction only, from the veins to the heart, and then from the heart to the arteries, preventing reverse flow. Without valves, blood would flow in both directions, and the heart would be unable to pump blood to the body.

If a heart valve is leaky, the blood transport process becomes difficult, the heart works under great pressure, and over time this can lead to heart failure. Therefore, severe cases of heart valve leakage accompanied by symptoms of heart failure often require surgery to repair or replace the valve.

Artificial heart valves come in two types: mechanical and biological. Mechanical valves are made of metal and have an average lifespan of 15-20 years, longer than biological valves. Patients must take anticoagulant medication (a type of vitamin K antagonist) for life to prevent the valve from seizing. Biological valves are made from the pericardium of pigs or cows, closely resembling the natural human valve. They have an average lifespan of 10-15 years, but tend to degenerate more quickly in younger patients. The advantage of biological valves is that patients only need to take anticoagulant medication for the first three months after surgery.

If your mother is elderly, the doctor may prioritize a biological valve so that she doesn't have to take anticoagulant medication for life. The valve can last up to 15 years if the patient follows the doctor's post-operative care instructions.

Currently, there are two surgical methods for heart valve replacement. For open-heart surgery, the surgeon makes an incision of about 20 cm in the middle of the chest, in front of the sternum. Patients need to stay in the hospital for 7-10 days after surgery; older patients may need to stay longer, up to 14 days, if there is no infection or complications. After about 6-8 weeks, patients can resume normal activities.

The second method is minimally invasive heart surgery. The incision is about 4-5 cm and a few small holes are made in the chest wall to insert the camera system and instruments. The advantages of this surgery are less pain, faster recovery, and patients are discharged early, after about 3-5 days.

After heart valve surgery, patients need to attend follow-up appointments to adjust medication. They must also take prescribed medication to prevent complications such as valve obstruction requiring further surgery. If any unusual symptoms appear, such as chest pain, shortness of breath, or slow wound healing, patients should be hospitalized immediately.

MSc. Dr. Huynh Thanh Kieu
Head of Department of Cardiology 1, Cardiology Center, Tam Anh General Hospital, Ho Chi Minh City

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