Valve replacement usually means that severe valve disease has existed, often accompanied by atrial dilatation, ventricular hypertrophy or dilatation, possible aortic dilatation and other cardiac functional impairment, including arrhythmia.
Mechanical valves result in an elevated thrombo-embolic stroke risk necessitating the use of anticoagulation with Warfarin. The target INR for aortic valve replacement is 2.0 – 3.0. The target INR for mitral valve replacement is 2.5-3.5, but these targets may be individualised depending on the patient and the type of prosthesis. See Use of Warfarin.
Novel Oral Anticoagulants (NOACs) such as Dabigatran, Rivaroxaban and similar are not currently considered appropriate prophylaxis in the case of mechanical valve replacement. This may change in the future.
Bio-prosthetic valves are safer in regard to the thrombo-embolic risk and generally do not require anticoagulation by Warfarin, Aspirin treatment being sufficient. They may not provide for ideal valve sizing and can result in less than optimal valvular function. They also have a more limited lifespan.
A heart that has undergone any form of surgery should be regarded as being compromised.
Valvular surgery is not cognitively benign. Cerebral impairment is a known complication following open heart surgery. Mood disorders, loss of confidence and anxiety are common post-operative features.
