MitralSolutions, Inc.

Mitral Valve Repair Versus Replacement

Current Limitations

Perceived as More Difficult than Replacement
Procedural skill required
Questionable durability
Lack of confidence
Limited technology

Compelling Advantages

Improve Heart Function
Improve Survivability & Reduce Need for Repeat Procedure(s)
Decrease In-Hospital Mortality & Length of Stay
Eliminate Lifelong Drug Therapy
Reduce Risk of Endocarditis and Stroke

Mechanical (Replacement)
Mechanical valves are made of pyrolytic carbon, titanium, and Dacron. Mechanical valves are made in two basic designs, bileaflet and tilting disk. Bileaflet valves, pioneered by St. Jude Medical in the 1980s, now dominate the market due primarily to better hemodynamic characteristics (smoother blood flow and smaller pressure gradients across the valve). Mechanical valves do not wear out, but patients must undertake a lifelong regimen of anticoagulant medication. The blood thinners are monitored regularly and kept within tight therapeutic ranges.

Tissue (Replacement)
Tissue valves are either fashioned from bovine heart tissue or are actual valves harvested from pigs. Most tissue valves include a wire stent as support for the leaflet structure. The bovine-derived tissue valves have an average life expectancy of 15-20 years and porcine valves have an average life expectancy of 10-15 years. Unlike patients with a mechanical valve, in most cases (except when patients have co-morbid atrial fibrillation) tissue valve patients do not have to take lifelong anticoagulant medication.

Allograft (Replacement)
Allograft valves are human valves harvested from cadavers and processed with tissue preservation techniques. Allografts are the most durable of tissue valves, but because the supply is limited, allografts are typically reserved for pediatric patients and women of childbearing years. This allograft subset of patients has been identified as requiring a durable valve while having a much higher risk profile for lifelong anticoagulation.

Repair
Annuloplasty rings are metal and fabric devices used to help repair faulty heart valves by reshaping and supporting the valve annulus so the leaflets can come together. Cardiovascular surgeons believe that repair is the preferred method over replacement, but the repair procedure is challenged by technical difficulties and related complexities

Valve Replacement vs. Valve Repair