43
Table 27. Prosthetic Valve Choice
Recommendations COR LOE
e choice of type of prosthetic heart valve should be a shared
decision making process that accounts for the patient's values
and preferences and includes discussion of the indications for
and risks of anticoagulant therapy and the potential need for
and risk associated with reintervention.
(Modified recommendation for 2017)
I C-LD
A bioprosthesis is recommended in patients of any age for
whom anticoagulant therapy is contraindicated, cannot be
managed appropriately, or is not desired.
I C
An aortic or mitral mechanical prosthesis is reasonable
for patients less than 50 years of age who do not have a
contraindication to anticoagulation.
(Modified recommendation for 2017)
IIa B-NR
For patients between 50 and 70 years of age, it is reasonable
to individualize the choice of either a mechanical or
bioprosthetic valve prosthesis on the basis of individual
patient factors and preferences, aer full discussion of the
trade-offs involved. (Modified recommendation for 2017)
IIa B-NR
A bioprosthesis is reasonable in patients >70 y of age. IIa B
Replacement of the aortic valve by a pulmonary autogra
(the Ross procedure), when performed by an experienced
surgeon, may be considered in young patients when VKA
anticoagulation is contraindicated or undesirable.
IIb C
