The choice between a mechanical valve and a stented bioprosthesis depends largely on patient age and the desire to avoid either anticoagulation complications or structural valve deterioration.
What factors determine the choice between a mechanical valve and a stented bioprosthesis in adults requiring a prosthetic heart valve?
The choice between mechanical and bioprosthetic heart valves in adults should be individualized based on age and patient preference regarding specific long-term complications, guided by a structured algorithm.
In the last 7 years, more data have reconfirmed that patients' comorbid conditions are very important factors determining patient outcomes. Prosthetic heart valves (PHVs) that require aortic root replacement in the absence of aortic root disease are associated with poorer outcomes. For the vast majority of patients, the choice of PHV is between a mechanical valve and a stented bioprosthesis. The choice is largely dependent upon the age of the patient at the time of PHV implantation and on which complication the patient wants to avoid: specifically, anticoagulation therapy and its complications with the mechanical valve, and structural valve deterioration with a bioprosthesis. Data on the pros and cons of the choices and exceptions to the rules are discussed, and a new algorithm is developed.
Shahbudin H. Rahimtoola (Wed,) conducted a review in Prosthetic heart valve replacement. Choice of Prosthetic Heart Valve (Mechanical vs Bioprosthesis) was evaluated. The choice between a mechanical valve and a stented bioprosthesis depends largely on patient age and the desire to avoid either anticoagulation complications or structural valve deterioration.