New Guidelines for Tissue-Valve Replacement

An American College of Cardiology (ACC, Bethesda, MD, USA) and American Heart Association (AHA, Dallas, TX, USA) joint committee has revised the guidelines for tissue-valve replacement, lowering the recommended minimum age for tissue mitral valve patients from 70 to 65 years.

The revised guidelines are intended to update guidance for internists, cardiologists, and surgeons as they diagnose disease, counsel patients, and plan valve-replacement procedures. Two significant revisions hold key implications for patient care. Responding to the increasing durability of valves crafted from animal tissues, the task force supported tissue-valve use for patients needing replacement of their mitral valves even if the patients are younger than 70. In the past, surgeons serving these patients typically selected mechanical metal valves because they were more likely to serve a younger patient for his or her increased lifespan.

The tradeoff, however, is the requirement that mechanical valves necessitate ongoing daily anticoagulant medication. The revised guidelines, in effect, encourage surgeons to offer tissue valves, which may not require years of anticoagulation, to appropriate younger patients who have active lifestyle considerations.

The second significant revision is that the committee recognized that technologic improvements have made today's second-generation porcine tissue valves for the aortic and mitral positions equivalent in durability to pericardial tissue valves made from bovine tissues. This equivalency further enlarges the range of options as surgeons discuss replacement with patients. A summary of the guidelines was published in the August 1, 2006, issue of the Journal of the American College of Cardiology and in Circulation.

The new recommendations offer the first comprehensive update to physician practice guidelines in this area since 1998. New data have led to more specific guidelines for physicians to manage the complexity of heart-valve disease, including determining the severity of the disease and the appropriate timing for heart valve surgery.



Related Links:
American College of Cardiology
American Heart Association