[Choice of a valve prosthesis in patients between 25 and 70 years of age]

In patients over the age of 70, the choice is unanimously in favour of a bioprosthesis. In children and adolescents, the rapid deterioration of bioprostheses makes them unsuitable for these patients. However, between the ages of 25 and 70, the situation is much more open to discussion. In the aortic orifice, because of the low risk of thrombo-embolism, there is a preference for a mechanical valve, except in the case of a young woman wishing to have a child or in the case of a contraindication to anticoagulants. In the mitral orifice, the higher incidence and the greater severity of the thrombo-embolic complications present an argument in favour of bioprostheses, which should be selected in the case of anticoagulant risks (contraindication, exposure to trauma, impossibility of following a female patient who wishes to become pregnant), in the case of a high thrombogenic risk (ectatic thrombosed left auricle or replacement of a thrombosed prosthesis) and, finally, the preference of the patient and the doctor. The bioprosthesis is unequivocally indicated in the case of tricuspid valve replacement.