Do you know Rheumatic Heart Disease can affect human valves? About 2-3% of our Indian population suffers from this disease, therefore; patients have to come for valve replacement, unfortunately.
In an already burdened situation for the family, surgeon faces a complicated choice of deciding a valve, tissue or metal valve and thus the confusion begins.
How to decide the valves?
As per the international standards, anyone is above 60 or 65 years of age, are offered tissue valves. However, it is not the same here as the average lifespan of the person is considered to be 67 years so the patients above 50-55 years of age are offered tissue valve and younger population are offered mechanical valves. It may also happen that based on the advancement of the disease, the doctor will decide which valve to be used for the patient. There is growing evidence available that the tissue valves last longer due to innovations in their development.
Dr. Manish Meswani helps us to understand broadly about the valves. Mechanical Valves last longer (roughly up to 20 to 35 years); tissue valve last for 10-15 years or may be longer. After having a mechanical valve, one has to take a blood thinning medication called as warfarin/acitrome, whose dosage has to be administered carefully. If the dosage goes low, the valve may be blocked, if it is high, the patient may experience heavy bleeding. As you may get older, there are chances that you can have bleeding in the brain due to this medication.
In Tissue valve, one does not have to take this medication for more than 3 months so no headache of monitoring is required. But as tissue valve lasts for a shorter time, the patient might have to go for a second surgery, if the valve does not work properly.
So younger the patient (< 50-55), the mechanical valve will be the choice, as the patient will not have to undergo surgery again, older the patient, tissue valve will be the choice. The exception will be a young female with child bearing age where tissue valve is done and a second surgery is advised to the patient after the family has been completed as warfarin can cause a problem to the baby in the womb.
There are no fixed rules and these options should be discussed clearly with every patient and family and choice of both valves should be given as many patients avoid taking medicines.