Prosthetic Valves
Table 29. Prosthetic Valve Choice
Recommendations COR LOE
e choice of valve intervention, that is, repair or replacement,
as well as type of prosthetic heart valve, should be a shared
decision-making process that accounts for the patient's values
and preferences, with full disclosure of the indications for and
risks of anticoagulant therapy and the potential need for and
risk of reoperation.
I C
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
A mechanical prosthesis is reasonable for AVR or MVR in
patients <60 y of age who do not have a contraindication to
anticoagulation.
IIa B
A bioprosthesis is reasonable in patients >70 y of age. IIa B
Either a bioprosthetic or mechanical valve is reasonable in
patients between 60 and 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
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