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Are the indications for tissue valves different in 2001 and how do we communicate these changes to our cardiology colleagues?

The indications for tissue valves in the aortic and mitral positions are becoming better defined with advances in valve design, valve preservation, and management of reoperations. Although some patients who require cardiac valve replacement clearly benefit more from one type of valve than from another, not infrequently one encounters a patient who is in the "gray zone," where the optimal choice is difficult. At present, bioprostheses for the diseased aortic valve include stented porcine and pericardial valves, stentless porcine valves, aortic homograft, and pulmonary autograft. For patients with mitral valve disease, options for tissue valve replacement are a stented porcine or pericardial prosthesis. Generally, factors to consider in choosing the appropriate valve substitute include the patient's age, expected life expectancy, coexisting medical problems, lifestyle, and socioeconomics; the etiology of the valve disease, annular size, and physician and patient preference are also relevant. Despite the known finite durability of tissue valves, which is the main limitation in their use, the long-term results have been satisfactory, particularly in older patients, patients with a limited life expectancy, and those undergoing valve replacement in the aortic position. Distillation of available information and ongoing communication between the surgeon and the cardiologist will enable us to assist the patient in choosing the best valve substitute.