The most common valves which need replacing are the aortic and mitral valve. There are two main options for replacement: biological (bioprosthetic) or mechanical.
| Biological (bioprosthetic) valves | Mechanical valves |
|---|---|
| Usually bovine or porcine in origin |
Major disadvantage is structural deterioration and calcification over time. Most older patients ( > 65 years for aortic valves and > 70 years for mitral valves) receive a bioprosthetic valve
Long-term anticoagulation not usually needed. Warfarin may be given for the first 3 months depending on patient factors. Low-dose aspirin is given long-term. | The most common type now implanted is the bileaflet valve. Ball-and-cage valves are rarely used nowadays
Mechanical valves have a low failure rateMajor disadvantage is the increased risk of thrombosis meaning long-term anticoagulation is needed.
Warfarin is still used in preference to DOACs for patients with mechanical heart valves
Following the 2017 European Society of Cardiology guidelines, aspirin is only normally given in addition if there is an additional indication, e.g. ischaemic heart disease. Target INR • aortic: 3.0 • mitral: 3.5 |
Following the 2008 NICE guidelines for prophylaxis of endocarditis antibiotics are no longer recommended for common procedures such as dental work.