Heart valve treatment options are multiplying. Dr. Anton Titov, MD. There is biological tissue prosthesis for mitral and aortic valves. There is stented and stentless replacement heart valves. There is open-heart surgery and transcatheter valve replacement. Dr. Anton Titov, MD. How to choose the correct type of heart surgery? How to choose the correct type of replacement heart valve for different patients? Dr. Anton Titov, MD. What are benefits and risks of each type of heart valve surgery? How to choose the correct replacement heart valve? Dr. Tsuyoshi Kaneko, MD. There are many options now available to patients. That is a very very good question. That is a very very difficult question too. To start off, there are two types of replacement heart valves. I think that'll be the main answer to this question. One type of heart valve is called a mechanical heart valve. This artificial valve is made out of carbon. Another heart valve for replacement is called a tissue valve. Dr. Tsuyoshi Kaneko, MD. Tissue heart valve is made out of either pig valve or a cow pericardial tissue. The benefit of mechanical valves is this. Mechanical heart valves last for a long time after you implant them. There are some situation where you have to exchange the mechanical heart valves. But those situations are very rare. Either the mitral valve thrombosis happens, aortic heart valves get stuck and have to be taken out. Or the replaced aortic valve gets infected. Those are the two cases when mechanical valve will need to be explanted [removed]. But the rates of mechanical heart valve problems are very very low. Dr. Tsuyoshi Kaneko, MD. The downside of mechanical valves are that you have to be on a blood thinner. Typically this medication is called coumadin. You are committed to a lifetime of using coumadin [warfarin]. That is the biggest burden of receiving a mechanical heart valve. Of course, the risk of coumadin is bleeding. We will discuss it later. But it's important to note that coumadin [warfarin] is not an innocuous medication. No, it's not. On the other hand the tissue mitral and aortic heart valves eliminate the need for coumadin. These are cow heart valves or pig heart valves. Dr. Tsuyoshi Kaneko, MD. The downside of tissue valve are that it does wear out with time. It really varies on the time period of how long a tissue replacement heart valve takes to wear out. You implant a tissue heart valve at a younger age. Then the aortic or mitral valve opens and closes much more. Because you are young and you are more active. Cow or pig heart valve may not even last ten years. You may be 75 and you live a very sedentary life. Your pig aortic valve valve won't open that much. Dr. Tsuyoshi Kaneko, MD. Therefore, cow mitral heart valve may last up to 15 years. It really varies how long tissue valve lasts. That typically has been one of the deciding factors in the past. For age 65 or younger, patients used to be recommended mechanical heart valves. Anybody above 65 used to get tissue heart valves. But that trend is changing now for multiple reasons. Dr. Anton Titov, MD. One is the emergence of TAVR / TAVI. Sometimes you receive a tissue heart valve and heart valve deteriorates. You can get TAVR later on. This eliminates open heart surgery. It lowers the hurdle of receiving tissue valves. Second, patients are pursuing active lifestyles. They don't want anticoagulation. It means that a 55-year-old person who wants to cycle, who wants to go out and hike really aggressively. Dr. Tsuyoshi Kaneko, MD. Those patients do not want coumadin. Those patients are starting to choose tissue heart valves more often. American Heart Association and American College of Cardiology provides guidelines of what valve to choose. But now the strongest recommendation is patient's preference. Patients get to choose aortic or mitral valve for replacement based on all the information that they get. Dr. Anton Titov, MD. The physician has to provide the important information for the patient. The patients ultimately get to choose if they want tissue or mechanical heart valve for replacement surgery.