Should I replace a biological or mechanical heart valve?

My mother is 72 years old, has severe mitral valve regurgitation, and is scheduled for valve replacement. Which type should she use? Does she have to take medication for the rest of her life? (Minh Anh, Ho Chi Minh City)

Reply:

The heart has 4 chambers (left atrium, right atrium, left ventricle, right ventricle) and 4 heart valves (mitral valve, tricuspid valve, aortic valve, pulmonary valve). Heart valves help blood flow in one direction, from the veins to the heart, then from the heart to the arteries, and cannot flow in the opposite direction. Without heart valves, blood would flow in two directions, and the heart would not be able to pump blood to nourish the body.

If the heart valve is leaky, the blood transport process will be difficult, the heart will work under great pressure, leading to heart failure over time. Therefore, severe cases of heart valve leak with symptoms of heart failure will often require surgery to repair or replace the heart valve.

There are two types of artificial heart valves: mechanical valves and biological valves. Mechanical valves are made of metal, with an average lifespan of 15-20 years, longer than biological valves. Patients must take anticoagulants that are anti-vitamin K for life to prevent the valve from getting stuck. Biological valves are made from the pericardium of pigs or cows, similar to natural human valves, with an average lifespan of 10-15 years. When replaced in a young person, the valve degenerates faster. The advantage of biological valves is that patients only need to take anticoagulants for the first three months after surgery.

If your mother is elderly, the doctor may choose a biological valve so that the patient does not have to take anticoagulants for the rest of her life. The valve can last up to 15 years if the patient follows the doctor's post-operative care instructions.

Currently, there are two methods of heart valve replacement surgery. For open surgery, the doctor will make an incision about 20 cm in the middle of the chest, in front of the sternum. The patient needs to stay in the hospital for 7-10 days after surgery, the elderly can stay in the hospital longer, up to 14 days, if there is no infection or complications. After about 6-8 weeks, the patient can return to 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 support system and instruments. The advantages of this surgery are less pain, quick recovery, and the patient can be discharged early after about 3-5 days.

After heart valve surgery, patients need to return for follow-up appointments to adjust their medications. At the same time, patients must take medication as prescribed by their doctor to prevent complications such as valve obstruction that require reoperation. If abnormal signs such as chest pain, shortness of breath, slow wound healing appear, etc., patients need to be hospitalized immediately.

Master, Doctor, Specialist II Huynh Thanh Kieu
Head of Cardiology Department 1, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City

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