🫀 Problems with prosthetic valve issues should be referred urgently to a Cardiologist.
Elective operative mortality ≈ 2%, but this risk rises in patients with IHD (often combined with CABG), lung disease, and the elderly.
| Feature |
Biological (Bioprosthetic) Valves |
Mechanical (Metal) Valves |
| 🖼️ Image |
 |
 |
| ⚙️ Material |
Porcine/bovine tissue, or human homografts. |
Titanium, carbon-based alloys. Eg. bileaflet designs. |
| ⏳ Longevity |
10–15 years (degenerates faster in younger pts). |
Durable, often 20–30+ years (can last lifetime). |
| 💊 Anticoagulation |
- Warfarin for 3 months, then stop if sinus rhythm.
- No lifelong anticoagulation needed in most.
|
- Requires lifelong anticoagulation (usually Warfarin).
- Target INR 2.5–3.5 depending on valve/site.
|
| 🩸 Thrombosis Risk |
Low (similar to native valve). |
High → hence mandatory anticoagulation. |
| 💨 Haemodynamics |
More physiological flow, lower gradients. |
Slightly less natural flow but durable. |
| 🦠 Endocarditis Risk |
Risk exists → antibiotic prophylaxis required in high-risk procedures. |
Similar risk; prosthetic valve endocarditis can be devastating. |
| 🎶 Sound |
Silent. |
Characteristic audible “click” on auscultation. |
| ⚠️ Complications |
- Structural deterioration (calcification, tearing).
- Re-operation often required after ~10–15 yrs.
|
- Valve thrombosis / emboli if anticoagulation suboptimal.
- Anticoagulant-related bleeding.
- Endocarditis.
|
| 👩⚕️ Clinical Indications |
- Older pts (>65 yrs).
- Contraindication to anticoagulation (bleeding risk, pregnancy planning).
|
- Younger pts (<65 yrs) due to durability.
- Pts already anticoagulated (e.g. AF, mechanical valves elsewhere).
|
| 🔖 Examples |
- Carpentier-Edwards (porcine).
- Homografts (cadaveric).
|
- Starr-Edwards (ball-cage).
- Bjork-Shiley (tilting disc).
- St Jude (bileaflet).
|
