Which is the best valve for aortic valve replacement?

Question

Hello doctor,

I am a 46-year-old male. I recently got the echo done and found issues with the aortic valve. The reports show:

Bicuspid, lateral cusp shows a 6.4 x 6.8 mm structure attached to its free surface.
Healed vegetation over lateral aortic cusp, severe eccentric AR, Mild TR, No PAH.
Mitral valve - normal. Tricuspid valve - normal.
Pulmonary valve - normal.

Doctors have recommended open-heart surgery. I am confused about which valve to go with. Should I go with a mechanical valve (metal) or a tissue valve? Please advise.

I am a vegetarian, non-alcoholic, non-smoker with healthy eating habits. I heard that the metal valve needs lots of attention to avoid clotting. Also, doctors told us that if I use the metal valve, I must avoid green veggies like broccoli, tomatoes, etc. Is this true?

I need the correct advice. I also heard that a person with a tissue valve can lead a normal life, but needs replacement later in life.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

You should go for a mechanical (metal) aortic valve. In patients under the age of 55 years, mechanical valves are recommended. The reason being the life of the bioprosthetic valve is not great in this age group, and it is bound to degenerate, requiring repeat valve replacement. So mechanical is the preferred one. And it is not easy to undergo repeat valve replacement, and it is riskier than the first surgery.

However, such patients need to remain on a blood thinner called a vitamin K antagonist lifelong, and repeated testing needs to be done to check that the blood is adequately thinned or not. Now green leafy vegetables contain vitamin K, which opposes this medicine.

One has to restrict their consumption, or one needs to eat them in the same quantity daily (as we can adjust the dose of medication for that particular level of vegetable consumption). So overall, despite these disadvantages, at this age, mechanical (metal) valves are recommended.

I hope this helps.

Thank you.