Selection of Valve Prostheses

The lack of an ideal prosthetic heart valve leaves surgeons and their patients with a difficult choice at the time of valve replacement surgery. Current guidelines mainly emphasize patient age, contraindications to anticoagulation, and patient desires in their recommendations for the type of prosthesis to implant. Aortic valve replacement is the most frequently performed valve replacement, and 5 articles in recent years have presented important data on outcomes with different prosthesis types. The findings suggest that in young patients, transvalvular prosthesis gradients have an effect on long-term bioprosthesis durability. Use of the bioprosthesis with the best hemodynamic profile for each patient may improve prosthesis longevity and negate the advantages of mechanical valves. In older patients, the new sutureless bioprostheses appear to facilitate surgical aortic valve replacement and become an alternative to transcatheter technologies in medium- to high-risk patients.