How long do aortic valves last

This review gathered data from 93 observational studies that followed long term outcomes for people with severe aortic stenosis who had the valve replaced with a biological or tissue bioprosthetic valve. Following surgery, survival ranged from 16 years on average for people aged 65 or less, to six or seven years for those over Fewer than one in developed a stroke each year. Bioprosthetic valves appear safe and are linked to average lifespan for this population, but there may be a need for monitoring and possible replacement after the first ten years.

The heart pumps blood through the aortic valve around the body. In many people the valve becomes narrower and less supple with age and this can put a strain on the heart as it works harder to pump blood. Symptoms include tiredness, feeling out of breath, chest pains, dizziness and fainting. Eventually aortic stenosis can lead to heart failure. People with severe symptoms can be helped by replacing the valve with a mechanical valve, or a bioprosthetic valve.

This systematic review explored long-term outcomes from surgical replacement with a bioprosthetic aortic valve, including mortality and valve deterioration. Transcatheter aortic valve replacement, a more recent minimally invasive technique which may be more suitable for some people, was not covered by this review. This systematic review identified 93 observational studies including a total 53, adults undergoing bioprosthetic aortic valve replacement for severe aortic stenosis.

Only studies published after were included to ensure relevance to current technologies. Patients were enrolled between and Average patient age was 53 to 92 years. The researchers carried out several subgroups analyses to examine the influence of different factors. These included patient age, whether the study also included mechanical valves, and risk of study bias.

Overall the risk of bias was assessed as low in 51 studies, moderate for 21, and high risk for 21 studies. NICE recommend transcatheter aortic valve implantation for people who are unsuitable for surgery.

This involves accessing the aorta via a catheter inserted into an artery in the groin or chest. However, the risks involved with this procedure mean that it is currently not recommended as an alternative for people otherwise suitable for surgery.

This guidance is under review. This is particularly important to young patients as earlier years of life are generally valued more than latter years. It may be more valuable, for example, spending the fourth and fifth decades of life, when most adults are in their prime, in excellent health free from anticoagulation, even if it meant having fair or poor health or reoperation when they are 60, as opposed to being in a fair state of health from age 40, with requirement for daily anticoagulation and attendant risks, and remaining so for the rest of their life.

Most young people would rather spend their prime years free from illness, obligatory medications, and hospitals. The low event rates with biologic valves therefore make them desirable for the young patient wishing to maintain health and independence for another decade or two. In contrast, mechanical valves are associated with a reoperation rate of 0. Several approaches to improved anticoagulation, such as use of novel anticoagulants, home International Normalized Ratio INR testing, and lower INR targets have not transformed to reduction in morbidity with mechanical valves 7, 8.

In one recent trial a bleeding rate of 3. One aspect that has not been studied is potential economic impact of prosthesis choice over the first decade.

Mechanical valves have constant stream of direct costs in terms of medication cost, INR testing and costs of hospitalizations related to bleeding and thromboembolism; this has to be compared to the costs of reoperations on early bioprosthetic valves. In addition mechanical valves have indirect costs of lost income during periods of hospitalization. It is probable that the costs of mechanical valves will exceed those of bioprosthesis in the mid-term, but this needs to be confirmed by formal study.

Reoperation rates are understated with mechanical and overstated with biological valves The major argument against use of biologic valves in young and middle aged patients is the inevitability of reintervention for structural valve failure.

In contrast, mechanical valves are often presented as a life-long solution. Are these views supported by evidence? A critical review of the literature will show that most patients receiving biologic valves will not have reoperations. Aortic stenosis, its cardiac sequalae, and its treatment all result in reduced life expectancy, regardless of therapy. The life expectancy after valve replacement varies with age, but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years Because death and structural valve degeneration are competing outcomes, and most biological valves have a median valve survival time to structural degeneration in the 10 to 15 year range, many patients will die before the valve degenerates.

For those patients, there would be no incremental benefit of a mechanical valve in terms of freedom from reoperation. Also important to note is that mechanical valves do not guarantee freedom from reoperation — prospective studies show a 0. Redo AVR is as safe as primary AVR It may seem implausible that the long-term survival curves for biological and mechanical valves are superimposed and similar in the second decade post-surgery, despite the former having more reoperations.

This is explained largely by the low mortality associated with reoperations. Aortic valves that can't open fully due to aortic valve stenosis may be repaired with surgery or temporarily with a less invasive procedure called balloon valvuloplasty — which uses an approach called cardiac catheterization.

You're usually awake during cardiac catheterization. During balloon valvuloplasty, your doctor inserts a thin, hollow tube catheter in a blood vessel, usually in your groin, and threads it to your heart. The catheter has a balloon at its tip that can be inflated to help stretch the narrowed aortic valve and then deflated for removal. Balloon valvuloplasty is often used to treat infants and children with aortic valve stenosis. However, the valve tends to narrow again in adults who have had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement.

You may need additional procedures to treat the narrowed valve over time. Some replacement heart valves may begin to leak or not work as well over time. These issues can be fixed using surgery or a catheter procedure to perform aortic valve repair by inserting a plug or device to fix a leaking replacement heart valve. In mechanical valve replacement, a mechanical valve replaces the damaged valve.

In biological valve replacement, a valve made from cow, pig or human heart tissue replaces the damaged valve. Transcatheter aortic valve replacement TAVR is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly aortic valve stenosis. In this procedure, doctors insert a catheter into the leg or chest and guide it to the heart. A replacement valve is inserted through the catheter and guided to the heart. A balloon is expanded to press the valve into place.

Some TAVR valves are self-expanding. In this procedure, your doctor removes the aortic valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue valve. Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible. Often, biological tissue valves eventually need to be replaced because they degenerate over time. If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots.

Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you. Aortic valve replacement surgery may be performed through traditional open-heart surgery or minimally invasive methods, which involve smaller incisions than those used in open-heart surgery.

Transcatheter aortic valve replacement TAVR is another type of minimally invasive aortic valve replacement that has a nonsurgical approach. It is also sometimes called transcatheter aortic valve implantation TAVI. But minimally invasive aortic valve replacement is less common because not all situations are best addressed by this method of access to the damaged valve. When performed by experienced surgeons and centers, the results are similar to those with traditional open-heart surgery.

If you had open-heart surgery, you'll generally spend a day or more in the intensive care unit ICU. You'll be given oxygen, fluids, nutrition and medications through intravenous IV lines.

Other tubes will drain urine from your bladder and drain fluid and blood from your chest. After the ICU , you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure.

Recovery time depends on your procedure, overall health before the procedure and any complications. Your doctor may advise you to avoid driving a car or lifting anything more than 10 pounds for several weeks. Your doctor will discuss with you when you can return to normal activities. Your Mayo Clinic treatment team will provide ongoing, coordinated care after aortic valve surgery.

After aortic valve repair or aortic valve replacement surgery, you may eventually be able to return to daily activities, such as working, driving and exercise. You'll still need to take certain medications and attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition. Your doctor and health care team may instruct you to incorporate healthy lifestyle changes — such as physical activity, a healthy diet, stress management and avoiding tobacco use — into your life to reduce the risk of future complications and promote a healthy heart.

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