Should I choose a mechanical or tissue (bioprosthetic) heart valve?
Mechanical valves last a lifetime but require lifelong blood-thinning medication (warfarin), with ongoing INR monitoring and bleeding risk. Tissue (bioprosthetic) valves avoid anticoagulation but degrade over 10-20 years and may require reoperation. The 2020 ACC/AHA guidelines recommend mechanical valves for patients under 50 and tissue valves for patients over 65, with shared decision-making for ages 50-65.
The complete answer.
The choice between mechanical and tissue valves is one of the most personal decisions in cardiac surgery. Key factors include patient age, lifestyle, compliance with medication, desire to avoid reoperation, and pregnancy planning (warfarin is teratogenic). Newer tissue valves may last 15-20 years in older patients. The valve-in-valve TAVR option now allows tissue valves that fail to be replaced via catheter rather than redo surgery, which has shifted some recommendations toward tissue valves at younger ages. The Ross procedure (using the patient's own pulmonary valve) offers a third option for young patients, avoiding both anticoagulation and limited durability.
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