State-of-the-Art Paper
Choice of Prosthetic Heart Valve in Adults: An Update

https://doi.org/10.1016/j.jacc.2009.10.085Get rights and content
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In the last 7 years, more data have reconfirmed that patients' comorbid conditions are very important factors determining patient outcomes. Prosthetic heart valves (PHVs) that require aortic root replacement in the absence of aortic root disease are associated with poorer outcomes. For the vast majority of patients, the choice of PHV is between a mechanical valve and a stented bioprosthesis. The choice is largely dependent upon the age of the patient at the time of PHV implantation and on which complication the patient wants to avoid: specifically, anticoagulation therapy and its complications with the mechanical valve, and structural valve deterioration with a bioprosthesis. Data on the pros and cons of the choices and exceptions to the rules are discussed, and a new algorithm is developed.

Key Words

aortic valve replacement
mitral valve replacement
mechanical heart valve
bioprosthesis
homograft
autograft

Abbreviations and Acronyms

AVR
aortic valve replacement
C-E
Carpentier Edwards
CHADS2
congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack
CI
confidence interval
HR
hazard ratio
MVR
mitral valve replacement
PHV
prosthetic heart valve
SVD
structural valve deterioration
TSPV
Toronto stentless porcine valve
VA
Veterans Administration
VP-PM
valve prosthesis–patient mismatch

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Dr. Rahimtoola has received honoraria for educational lectures from the American College of Cardiology Foundation, American College of Physicians, University of California Los Angeles, University of California Irvine, Cornell University, Creighton University, Thomas Jefferson University, Cedars-Sinai Medical Center, Harvard Medical School, University of Wisconsin, University of Hawaii, Cardiologists Association of Hong Kong, China, San Bernardino Medical Center, ATS, St. Jude Medical, Carbomedics, Edwards Lifesciences, Merck, and Pfizer.