Aortic valve replacement

Indicated for survival benefit, symptom relief, and preservation of left ventricular function in patients with aortic valve disease.

Approximately 50,000 cases of aortic valve replacement occur annually in the US.

In elderly patients bioprosthetic valves are associated with a low lifetime risk of re-operation due to structural degeneration and avoid major thrombotic and hemorrhagic complications associated with mechanical prostheses.

Bioprosthetic valve are therefore recommended in patients older than 70 years, but the optimal prosthesis type for younger patients is less clear.

Bioprosthetic valves have structural degeneration earlier and progresses more rapidly in younger patients, resulting in a higher risk of re-operation.

Among patients age 50-69 years who underwent valve replacement with bioprosthetic compared with mechanical valves showed no difference in 15 year survival or stroke.

Patients in the bioprosthetic valve group had a greater likelihood of re-operation but a lower likelihood of major bleeding (Chiang YP).

Present guidelines suggest that the choice of either a bioprosthetic or mechanical prosthetic aortic valve is reasonable in patient’s age 60-70 years, and that a mechanical valve replacement is reasonable in patients younger than 60 years without contraindications to Coumadin: this recommendation could also be reasonably extended to include patients age 50-59 years.

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