Aortic valve stenosis: Should I choose a mechanical valve or tissue valve to replace my aortic valve?

1. Get the Facts

Your options

Get a mechanical replacement valve.
Get a tissue replacement valve.

Key points to remember

There are two main differences between mechanical and tissue valves. One is how long they last. The other is the risk of blood clots. A mechanical valve will last 20 to 30 years. A tissue valve will last about 8 to 15 years. But the risk of blood clotting is higher with a mechanical valve. Blood clots can cause a heart attack or a stroke.
If you are 60 or younger, a mechanical valve may be your best choice. That's because you are young enough that you probably would live longer than a tissue valve would last. A mechanical valve also may work better for you because tissue valves can become hardened, or calcified, in people age 60 or younger.
If you choose a mechanical valve, you will have to take a blood-thinning medicine (anticoagulant) every day for as long as you have the valve. This will lower your risk of blood clots. If you choose a tissue valve, you will need to take blood thinners for only a few months after surgery.
Women who may want to become pregnant and who are considering valve replacement surgery may want to consider a tissue valve. Mechanical valves require long-term use of anticoagulants, which may be harmful to a developing fetus.
A mechanical valve may be your best choice if you are already taking blood thinners for another health problem.

FAQs

What is aortic valve stenosis?

Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle.

Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to heart failure.

What are the differences between mechanical and tissue valves?

A tissue valve doesn't last as long as a mechanical valve. But if you get a mechanical valve, you will need to take a blood-thinning medicine (anticoagulant).

Tissue valves:

Last 8 to 15 years. If you get a tissue valve, you may need a second valve replacement later.
Can fail because of the same hardening, or calcification, that damaged the original valve.
May tear or get infected.

Mechanical valves:

Last 20 to 30 years. You are less likely to replace a mechanical valve in your lifetime.
Can break down, but this is very rare.
Have a higher risk of causing blood clotting. To prevent clots, you'll need to take a blood-thinning medicine for as long as you have the mechanical valve.

Blood-thinning medicines have risks. These medicines can increase your risk of bleeding. If you get injured while you are taking blood-thinners, you risk bleeding too much. You'll need to avoid activities that have a high risk for injury, such as skiing or contact sports like football.

You will need to get regular blood tests to make sure you are taking the right amount of blood-thinning medicine. And you'll need to tell your doctor about any other medicines or vitamins you are taking. These may interfere with blood thinners.

Why is blood clotting more likely with a mechanical valve?

Because your body can tell that a mechanical valve is not made of natural tissue, your blood is more likely to clot on the surface of the valve. The pieces of the valve are also hard, unlike the soft tissue of a natural valve. These pieces can tear blood cells as they pass through the valve. This causes blood clots to form.

Why might your doctor recommend one type of valve over the other?

Your doctor might recommend a mechanical valve if:

You are already taking blood-thinning medicines for another health problem.
You are age 60 or younger.

Your doctor may recommend a tissue valve if:

You are older than 65.
You are younger than 60 and have severe lung disease, heart failure, or coronary artery disease.
You have kidney disease.
You have a life expectancy of less than 10 years.

2. Compare Options

	Get a mechanical valve	Get a tissue valve
What is usually involved?	You will stay in the hospital for 4 to 5 days after surgery. You will have a big scar on your chest from the incision. It can take 3 to 6 weeks to recover at home. You will take blood-thinning medicine for as long as you have the valve. You'll have regular blood tests to make sure that the blood-thinning medicine is working.	You will stay in the hospital for 4 to 5 days after surgery. You will have a big scar on your chest from the incision. It can take 3 to 6 weeks to recover at home. You'll take blood thinning medicine for a few months after surgery, then take an aspirin every day after that.
What are the benefits?	A mechanical valve lasts 20 to 30 years. You probably will not need another valve replacement in your lifetime.	You won't have to take blood-thinning medicine for the rest of your life.
What are the risks and side effects?	These valves have a high risk of causing blood clotting. Blood clots can cause a heart attack or stroke. You'll need to take blood-thinning medicine as long as you have the valve. This medicine raises your risk of bleeding. You'll need to avoid activities that have a high risk of injury, such as skiing or contact sports. Mechanical valves can break down, but this is very rare.	Tissue valves last 8 to 15 years. If you are 60 or younger, you may outlive a tissue valve and need another. Tissue valves can become hardened, or calcified, over time. There is a rare risk of tissue valve failure or infection.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Aortic Valve Stenosis.

Personal stories about mechanical and tissue replacement aortic valves

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was born with a bicuspid aortic valve. The valve has two leaflets instead of the three it's supposed to have. I'm going to have a mechanical valve, mainly because of my age—I'm only 25, so I know that if I have a tissue valve, I'll have to have it replaced at least once, and probably twice. My doctor says that tissue valves also can become hardened in younger people. "

— Roy, age 25

"When I found out that I had a narrowed aortic valve, I talked with my doctor about what type of valve I should have. We agreed that because I'm 72, a tissue valve would be fine. They last for 10 to 15 years, and sometimes as long as 20. Besides, I won't have to take anticoagulants every day for the rest of my life. "

— Rhonda, age 72

"I take anticoagulants for another heart condition. My doctor said that because I take this medicine anyway, I should consider having a mechanical valve because it will last longer than a tissue valve. "

— Chantal, age 51

"I decided to have a tissue replacement valve because I have a history of bleeding stomach ulcers. If I get a mechanical valve, I will need to take anticoagulants every day, and they can increase the risk of bleeding. So a tissue valve is a better option for me. "

— Maurice, age 57

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose a mechanical valve

Reasons to choose a tissue valve

I am young enough that I would outlive a tissue valve.

I am older than 65, so a tissue valve will probably last the rest of my life.

More important

Equally important

More important

I don't mind taking blood-thinning medicine for the rest of my life.

I don't want to take blood thinning medicine for the rest of my life.

More important

Equally important

More important

For me, the benefits of a mechanical valve outweigh the risks of blood clotting.

I'm worried about the risks of blood clots with a mechanical valve.

More important

Equally important

More important

I accept the risk of bleeding that comes with taking blood-thinning medicine.

I have concerns about the risk of bleeding with blood-thinning medicine.

More important

Equally important

More important

I'm willing to change the kinds of activities I do to reduce my risk of injury and bleeding.

I'm not willing to change the kinds of activities I do.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting a mechanical valve

Getting a tissue valve

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Which type of valve lasts longer?

A tissue valve
A mechanical valve
I'm not sure

You are right. A mechanical valve will last 20 to 30 years. A tissue valve will last about 8 to 15 years.

2. Which valve has a higher risk of causing blood clots?

A tissue valve
A mechanical valve
I'm not sure

You are right. The risk of blood clots is higher with a mechanical valve.

3. What kind of valve requires you to take blood thinners for the rest of your life?

A tissue valve
A mechanical valve
I'm not sure

That's right. If you choose a mechanical valve, you will need to take blood thinners for the rest of your life.

Decide what's next.

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a choice?

Yes
No

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.