[Selection criteria for aortic valve prostheses: mechanical, stented, or stentless valve or homograft?]

A bioprosthesis is recommended for aortic valve replacement in patients 70 years (recently, 72 or 73 years) of age or older. The bovine pericardial valve is better suited in patients with a small aortic annulus less than 23 mm in diameter, and the porcine stented-bioprosthesis should be used in patients with an annulus larger than 25 mm. A mechanical valve is recommended in patients younger than 70 years of age with chronic atrial fibrillation or a history of thromboembolism. Moreover, a mechanical valve is selected in patients in whom it is necessary to enlarge the aortic root or annulus. When mitral valve replacement or coronary artery bypass grafting in performed concomitantly, the valve prosthesis is selected according to the age of the patient. A homograft is indicated in patients with active valve endocarditis having an abscess at the aortic annulus or root. When a patient with poor ventricular performance resulting from valvular disease is expected to undergo implantation of a ventricular assist device in the near future, a bioprosthesis is preferable.