Biological Valves in Younger Patients Undergoing Aortic Valve Replacement

ortic stenosis is becoming more prevalent as populations age, and surgically implanting a replacement valve can restore a patient's expected life span.There is much discussion about the relative merits of a mechanical or biological valve design.A mechanical valve is expected to outlast the patient but requires anticoagulation with a vitamin K antagonist, whereas a biological valve does not require anticoagulation but is subject to structural valve degeneration after 10 years.After taking patient preferences into consideration, the 2014 American Heart Association/American College of Cardiology guidelines 1 recommend that a mechanical valve should be implanted in patients <60 years of age and a biological one in those >65 years of age.However, biological valves are increasingly being used in patients <60 years of age in both the United States and Europe.In the United Kingdom, successive registry returns from cardiac surgical centers show that the percentage of biological valves implanted in patients <60 years of age is increasing rapidly.Drivers of this trend include the perceived longer durability of newer biological valves, the ability to intervene for structural valve degeneration with a valve-in-valve transcatheter aortic valve replacement (TAVR), and the inconvenience and bleeding risks from anticoagulant therapy.We argue that there is insufficient evidence to justify this downward shift in the age at which biological valves are used. Biological Valves in Younger Patients Undergoing Aortic Valve ReplacementA Word of Caution