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How safe is aortic valve replacement?

Q: My dad is having blood leak in the aortic valve. He is 58 years old. We had an angiogram done which showed severe blood leak. Doctors say that it is a birth problem. He has a bicuspid instead of tricuspid valve. The only way out is to do Open Heart Surgery and replace the valve with either mechanical or biological valve. They say both valves have advantages & disadvantages. The mechanical valves last longer but require anti-clot medicines daily and in case of injury the bleeding cant be controlled. The biological valve doesnt require this medicine but has a life of only 12-15 years and then needs to be replaced. I am confused regarding which valve to select. Moreover, how complex is this operation and what are the risks involved? Kindly help me understand and decide.

A:The information that you have been given is broadly true. Mechanical valves do need lifelong anticoagulation but are very durable. Tissue valves do not need anticoagulation but their functional life may be better than you have been led to believe. Whilst it is true that approximately 15-20% may mail within 10-15 years, the majority go on for much longer, and indeed many will never need replacing. The operation whilst being open heart surgery and thereby a serious affair, these days carries a low risk of 1-3% mortality and lower in some hands. Approximately 0.1% in my hands here at Papworth. In addition, redo surgery is also quite safe these days all adding up to the preferred use of a tissue valve in my hands for the over 55 year old patient. I hope this is helpful for you.


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