Mechanical heart valves were the first types of artificial heart valves to achieve long-term success.

These mechanical prostheses are made from carbon, metallic and polymeric components. Although mechanical valves provide long-term durability while maintaining the mechanical properties necessary for proper function, they require permanent anticoagulation treatment to reduce the immune response in the patient. Other complications that can arise include thrombus formation, endocarditis, growth of vegetation, and other thromboembolic complications. Implantation of these devices requires open-heart surgery, which introduces even more risks. The three major types of mechanical heart valves are the caged-ball valves, tilting disk valves, and bileaflet valves. The first artificial heart valve to be implanted was the caged-ball valve in 1952. These valves utilized a silicone elastomer ball housed inside a metal cage. An improved design known as the Starr-Edwards Silaastic Ball Valve was introduced in 1960. It is comprised of a silicone ball enclosed in a cage formed from metal wires. As the heart contracts, blood pressure within the heart chamber exceeds the pressure on the outside of the chamber. This pushes the ball against the cage and allows blood to flow. When the contraction phase is over, the pressure inside the chamber drops and the ball moves back against the base of the valve. Cagedball valves have a tendency to form blood clots so they require a lot of anticoagulation therapy. Also, the movement of the ball can damage blood cells. The first clinically available tilting-disk valve was the Bjork-Shiley valve introduced in 19696. The tilting-disk valve has a single circular occluder controlled by metal struts. The disk and struts are attached to metal ring covered by a fabric of expanded polytetrafluoroethylene (ePTFE). The disk is usually made of a very hard carbon material, such as pyrolytic carbon. Pyrolytic carbon is very useful for this application because it is biocompatible, thromboresistant, resistant to wear, and has high strength and durability. The mechanism of action is the same as that of the caged-ball design. The disk opens at an angle of 60 degrees and about 70 beats per minute. The use of a disk as well as the angular opening provides advantages over the caged-ball designs such as reducing damage to blood cells, but the struts are susceptible to fatigue and fracture over long periods of time.
Figure 1: Common types of heart valve prostheses: St Jude's Medical bileaflet (top left); Starr-Edwards ball and cage (top right); Bjork-Shiley tilting disc (bottom right); stented porcine prosthesis (bottom left).

The bileaflet valve was introduced in 1979 by the St. Jude Medical Company6. It is comprised of two semicircular leaflets that rotate about struts attached to the valve housing like hinges. The valve is entirely made of pyrolytic carbon and does not contain any stainless steel used in previous designs. This is important because it means that the patient requires only mild anticoagulation therapy6. Bileaflet valves provide a more natural, centralized blood flow with little resistance. The openings of the leaflets also reduce the damage to blood cells. However, they can allow some backflow, which is a major design flaw. Many natural heart valves are replaced with mechanical valves because they became too stiff and allowed back flow12. Bileaflet heart valves are the most commonly used mechanical valves today because of their biocompatibility, they allow the least resistance to flow and provide the least damage to blood cells.