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Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Non-Interactive Decision Point

Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Get the facts

Your options

  • Get a mechanical replacement valve.
  • Get a tissue replacement valve.

Key points to remember

  • Mechanical valves usually last 20 years or more. You are less likely to need a mechanical valve replaced in your lifetime. But they can cause blood clots, so you'll take a blood thinner called warfarin (such as Coumadin).
  • Tissue valves are less likely to cause blood clots, so you don't have to take warfarin. But tissue valves don't last as long as mechanical valves, so you may need it replaced. Tissue valves last about 10 to 18 years.
  • You and your doctor will consider your age, your other health problems, and how you feel about needing another valve replacement in the future or about taking warfarin.
FAQs

What heart valve problems might need a valve replaced?

Heart valve problems that might need a valve replaced include:

What are the risks of mechanical valves?

The main risk of a mechanical valve is that you can get blood clots that could cause a heart attack or stroke. To prevent blood clots, you will take a blood thinner called warfarin (such as Coumadin) every day.

Because your body can tell that a mechanical valve is not made of natural tissue, your blood is more likely to clot on the surface of the valve. The pieces of the valve are also hard, unlike the soft tissue of a natural valve. These pieces can tear blood cells as they pass through the valve. This causes blood clots to form.

Risk of bleeding with warfarin

When you take warfarin, your blood clots slower than normal. This increases your risk of bleeding in and around the brain, bleeding in the stomach and intestines, and bruising and bleeding if you are hurt.

Each year about 1 to 3 out of 100 people who take warfarin will have a problem with severe bleeding inside the body. This means that 97 to 99 out of 100 people will not have a severe bleeding problem.footnote 1 Your own risk of bleeding may be higher or lower than average, based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.

If you take warfarin, you will take extra steps to use this medicine safely. This includes getting regular blood tests, preventing injuries, and eating about the same amount of vitamin K every day.

What are the risks of tissue valves?

The main risk of a tissue valve is that it may wear out in about 10 to 18 years. If your tissue valve wears out, you will need another surgery or procedure to replace the valve. Tissue valves may tear, and they can fail because of the same hardening, or calcification, that damaged the original valve.

If you are older when you get the valve, it is less likely to wear out in your lifetime. So you are less likely to need another surgery or procedure to replace the valve. If you are younger when you get the valve, you have a higher chance of the valve wearing out. So you are more likely to need the valve replaced.

For example, in people who get a tissue valve when they are 70, about 1 out of 10 need another valve in about 15 years. That means that 9 out of 10 will not need another valve. In people who get a tissue valve when they are 40, about 3 out of 10 need another valve in about 15 years. That means that 7 out of 10 do not need another valve.footnote 2

Your doctor can help you understand your risk of needing another surgery or procedure to replace your valve. Your doctor also can help you understand the risks of a valve replacement based on your age and health.

Mechanical valves last longer

Mechanical valves last longer than tissue valves. They are less likely to wear out or break down. If you are age 50 or younger, a mechanical valve may be a good choice. That's because you are young enough that you probably will live longer than a tissue valve might last. A mechanical valve also may work better for you because tissue valves can become hardened, or calcified, in younger people.

Why might your doctor recommend one type of valve over the other?

Your doctor might recommend a mechanical valve if:

  • You are already taking warfarin for another health problem.
  • You are age 50 or younger.
  • You are willing to take warfarin and can take it safely.

Your doctor may recommend a tissue valve if:

  • You are older than 70.
  • You do not want to take warfarin or you cannot take it safely.
  • You are willing to have another valve replacement surgery or procedure when the tissue valve wears out.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Get a mechanical valve Get a mechanical valve
  • You will take the blood-thinning medicine called warfarin (such as Coumadin). You will take extra steps to take the medicine safely, such as getting regular blood tests and preventing injuries.
  • A mechanical valve usually lasts 20 years or more. You have a small chance of needing another valve replacement in your lifetime.
  • These valves have a high risk of causing blood clotting. Blood clots can cause a heart attack or stroke.
  • Warfarin raises your risk of bleeding.
  • Mechanical valves can break down. But this is very rare.
Get a tissue valve Get a tissue valve
  • You might take warfarin for a few months after surgery, then take an aspirin every day after that.
  • You won't have to take warfarin (such as Coumadin) for the rest of your life (unless you are taking it for another health problem).
  • A tissue valve lasts about 10 to 18 years. Depending on your age, you may outlive a tissue valve and need another.
  • Tissue valves can become hardened, or calcified, over time.
  • There is a rare risk of tissue valve failure or infection.

Personal stories about mechanical and tissue replacement heart valves

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was born with a bicuspid aortic valve. The valve has two leaflets instead of the three it's supposed to have. I'm going to have a mechanical valve, mainly because of my age-I'm only 25, so I know that if I have a tissue valve, I'll have to have it replaced at least once, and probably twice. My doctor says that tissue valves also can become hardened in younger people.

Roy, age 25

When I found out that I had a narrowed aortic valve, I talked with my doctor about what type of valve I should have. We agreed that because I'm 72, a tissue valve would be fine. It should last for as long as I live. Plus I won't have to take warfarin every day for the rest of my life.

Rhonda, age 72

I take warfarin for another heart condition. My doctor said that because I take this medicine anyway, I should consider having a mechanical valve because it will last longer than a tissue valve.

Chantal, age 51

I decided to have a tissue replacement valve because I have a history of bleeding stomach ulcers. If I get a mechanical valve, I will need to take warfarin and it can increase the risk of bleeding. So a tissue valve is a better option for me.

Maurice, age 57

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose a mechanical valve

Reasons to choose a tissue valve

I am young enough that I would outlive a tissue valve.

I am older, so a tissue valve will probably last the rest of my life.

More important
Equally important
More important

I don't mind taking warfarin for the rest of my life.

I don't want to take warfarin for the rest of my life.

More important
Equally important
More important

For me, the benefits of a mechanical valve outweigh the risks of blood clotting.

I'm worried about the risks of blood clots with a mechanical valve.

More important
Equally important
More important

I accept the risk of bleeding that comes with taking warfarin.

I have concerns about the risk of bleeding that comes with warfarin.

More important
Equally important
More important

I'm willing to make the extra effort to take warfarin safely.

I'm not willing to change things in my life to take warfarin.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting a mechanical valve

Getting a tissue valve

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Which type of valve lasts longer?
2, Which valve has a higher risk of causing blood clots?
3, What kind of valve requires you to take warfarin (such as Coumadin) for the rest of your life?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerMartin J. Gabica, MD - Family Medicine
Primary Medical ReviewerElizabeth T. Russo, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
References
Citations
  1. Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics, 56(1454): 103-108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22, 2014.
  2. Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
Other Works Consulted
  • Fihn SD, et al. (1996). The risk for and severity of bleeding complications in elderly patients treated with warfarin. Annals of Internal Medicine, 124(11): 970-979. DOI:10.7326/0003-4819-124-11-199606010-00004. Accessed January 27, 2015.
  • Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
  • Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
  • Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955-962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15, 2014.
  • Whitlock RP, et al. (2012). Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.-American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e576S-e600S.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Get a mechanical replacement valve.
  • Get a tissue replacement valve.

Key points to remember

  • Mechanical valves usually last 20 years or more. You are less likely to need a mechanical valve replaced in your lifetime. But they can cause blood clots, so you'll take a blood thinner called warfarin (such as Coumadin).
  • Tissue valves are less likely to cause blood clots, so you don't have to take warfarin. But tissue valves don't last as long as mechanical valves, so you may need it replaced. Tissue valves last about 10 to 18 years.
  • You and your doctor will consider your age, your other health problems, and how you feel about needing another valve replacement in the future or about taking warfarin.
FAQs

What heart valve problems might need a valve replaced?

Heart valve problems that might need a valve replaced include:

What are the risks of mechanical valves?

The main risk of a mechanical valve is that you can get blood clots that could cause a heart attack or stroke. To prevent blood clots, you will take a blood thinner called warfarin (such as Coumadin) every day.

Because your body can tell that a mechanical valve is not made of natural tissue, your blood is more likely to clot on the surface of the valve. The pieces of the valve are also hard, unlike the soft tissue of a natural valve. These pieces can tear blood cells as they pass through the valve. This causes blood clots to form.

Risk of bleeding with warfarin

When you take warfarin, your blood clots slower than normal. This increases your risk of bleeding in and around the brain, bleeding in the stomach and intestines, and bruising and bleeding if you are hurt.

Each year about 1 to 3 out of 100 people who take warfarin will have a problem with severe bleeding inside the body. This means that 97 to 99 out of 100 people will not have a severe bleeding problem.1 Your own risk of bleeding may be higher or lower than average, based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.

If you take warfarin, you will take extra steps to use this medicine safely. This includes getting regular blood tests, preventing injuries, and eating about the same amount of vitamin K every day.

What are the risks of tissue valves?

The main risk of a tissue valve is that it may wear out in about 10 to 18 years. If your tissue valve wears out, you will need another surgery or procedure to replace the valve. Tissue valves may tear, and they can fail because of the same hardening, or calcification, that damaged the original valve.

If you are older when you get the valve, it is less likely to wear out in your lifetime. So you are less likely to need another surgery or procedure to replace the valve. If you are younger when you get the valve, you have a higher chance of the valve wearing out. So you are more likely to need the valve replaced.

For example, in people who get a tissue valve when they are 70, about 1 out of 10 need another valve in about 15 years. That means that 9 out of 10 will not need another valve. In people who get a tissue valve when they are 40, about 3 out of 10 need another valve in about 15 years. That means that 7 out of 10 do not need another valve.2

Your doctor can help you understand your risk of needing another surgery or procedure to replace your valve. Your doctor also can help you understand the risks of a valve replacement based on your age and health.

Mechanical valves last longer

Mechanical valves last longer than tissue valves. They are less likely to wear out or break down. If you are age 50 or younger, a mechanical valve may be a good choice. That's because you are young enough that you probably will live longer than a tissue valve might last. A mechanical valve also may work better for you because tissue valves can become hardened, or calcified, in younger people.

Why might your doctor recommend one type of valve over the other?

Your doctor might recommend a mechanical valve if:

  • You are already taking warfarin for another health problem.
  • You are age 50 or younger.
  • You are willing to take warfarin and can take it safely.

Your doctor may recommend a tissue valve if:

  • You are older than 70.
  • You do not want to take warfarin or you cannot take it safely.
  • You are willing to have another valve replacement surgery or procedure when the tissue valve wears out.

2. Compare your options

  Get a mechanical valve Get a tissue valve
What is usually involved?
  • You will take the blood-thinning medicine called warfarin (such as Coumadin). You will take extra steps to take the medicine safely, such as getting regular blood tests and preventing injuries.
  • You might take warfarin for a few months after surgery, then take an aspirin every day after that.
What are the benefits?
  • A mechanical valve usually lasts 20 years or more. You have a small chance of needing another valve replacement in your lifetime.
  • You won't have to take warfarin (such as Coumadin) for the rest of your life (unless you are taking it for another health problem).
What are the risks and side effects?
  • These valves have a high risk of causing blood clotting. Blood clots can cause a heart attack or stroke.
  • Warfarin raises your risk of bleeding.
  • Mechanical valves can break down. But this is very rare.
  • A tissue valve lasts about 10 to 18 years. Depending on your age, you may outlive a tissue valve and need another.
  • Tissue valves can become hardened, or calcified, over time.
  • There is a rare risk of tissue valve failure or infection.

Personal stories

Personal stories about mechanical and tissue replacement heart valves

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was born with a bicuspid aortic valve. The valve has two leaflets instead of the three it's supposed to have. I'm going to have a mechanical valve, mainly because of my age-I'm only 25, so I know that if I have a tissue valve, I'll have to have it replaced at least once, and probably twice. My doctor says that tissue valves also can become hardened in younger people."

— Roy, age 25

"When I found out that I had a narrowed aortic valve, I talked with my doctor about what type of valve I should have. We agreed that because I'm 72, a tissue valve would be fine. It should last for as long as I live. Plus I won't have to take warfarin every day for the rest of my life."

— Rhonda, age 72

"I take warfarin for another heart condition. My doctor said that because I take this medicine anyway, I should consider having a mechanical valve because it will last longer than a tissue valve."

— Chantal, age 51

"I decided to have a tissue replacement valve because I have a history of bleeding stomach ulcers. If I get a mechanical valve, I will need to take warfarin and it can increase the risk of bleeding. So a tissue valve is a better option for me."

— Maurice, age 57

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose a mechanical valve

Reasons to choose a tissue valve

I am young enough that I would outlive a tissue valve.

I am older, so a tissue valve will probably last the rest of my life.

       
More important
Equally important
More important

I don't mind taking warfarin for the rest of my life.

I don't want to take warfarin for the rest of my life.

       
More important
Equally important
More important

For me, the benefits of a mechanical valve outweigh the risks of blood clotting.

I'm worried about the risks of blood clots with a mechanical valve.

       
More important
Equally important
More important

I accept the risk of bleeding that comes with taking warfarin.

I have concerns about the risk of bleeding that comes with warfarin.

       
More important
Equally important
More important

I'm willing to make the extra effort to take warfarin safely.

I'm not willing to change things in my life to take warfarin.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting a mechanical valve

Getting a tissue valve

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Which type of valve lasts longer?

  • A tissue valve
  • A mechanical valve
  • I'm not sure
You are right. A mechanical valve usually lasts 20 years or more. A tissue valve lasts about 10 to 18 years.

2. Which valve has a higher risk of causing blood clots?

  • A tissue valve
  • A mechanical valve
  • I'm not sure
You are right. The risk of blood clots is higher with a mechanical valve.

3. What kind of valve requires you to take warfarin (such as Coumadin) for the rest of your life?

  • A tissue valve
  • A mechanical valve
  • I'm not sure
That's right. If you choose a mechanical valve, you will need to take warfarin (such as Coumadin) for the rest of your life.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerMartin J. Gabica, MD - Family Medicine
Primary Medical ReviewerElizabeth T. Russo, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
References
Citations
  1. Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics, 56(1454): 103-108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22, 2014.
  2. Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
Other Works Consulted
  • Fihn SD, et al. (1996). The risk for and severity of bleeding complications in elderly patients treated with warfarin. Annals of Internal Medicine, 124(11): 970-979. DOI:10.7326/0003-4819-124-11-199606010-00004. Accessed January 27, 2015.
  • Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
  • Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
  • Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955-962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15, 2014.
  • Whitlock RP, et al. (2012). Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.-American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e576S-e600S.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: February 23, 2018

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology