44
Prosthetic Valves
Table 28. Factors Used for Shared Decision Making About
Type of Valve Prosthesis
Favor Mechanical Prosthesis Favor Bioprosthesis
Age <50 y
• Increased incidence of structural
deterioration with bioprosthesis (15-y
risk: 30% for age 40 y, 50% for age 20 y)
• Lower risk of anticoagulation
complications
Age >70 y
• Low incidence of structural
deterioration (15- y risk: <10% for
age >70 y)
• Higher risk of anticoagulation
complications
Patient preference (avoid risk of
reintervention)
Patient preference (avoid risk and
inconvenience of anticoagulation and
absence of valve sounds)
Low risk of long-term anticoagulation High risk of long-term anticoagulation
Compliant patient with either home
monitoring or close access to INR
monitoring
Limited access to medical care or
inability to regulate VKA
Other indication for long-term
anticoagulation (e.g., AF)
Access to surgical centers with low
reoperation mortality rate
High-risk reintervention (e.g., porcelain
aorta, prior radiation therapy)
Small aortic root size for AVR (may
preclude valve-in-valve procedure in future)
