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JAMA Cardiology Clinical Guidelines Synopsis
March 2018

Guideline Update on Evaluation and Selection of Prosthetic Valves

Author Affiliations
  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Centro Cardiologico Gentile, Naples, Italy
  • 3Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Editor, JAMA Cardiology
JAMA Cardiol. 2018;3(3):260-261. doi:10.1001/jamacardio.2017.5123

The choice of a cardiac valve prosthesis must be based on several factors related to the prosthesis (valve durability, expected hemodynamics, and need for anticoagulation) as well as for the individual patient (surgical or interventional risk, reoperative risk, bleeding risk) and, most importantly, the patient’s own values and preferences. For bioprosthetic valves, there is a potential need for reintervention owing to structural valve deterioration. For mechanical prosthesis, there is a risk and inconvenience associated with long-term anticoagulation. Age plays a major role because the incidence of structural deterioration of a bioprosthesis is greater in younger patients, but the risk of bleeding from anticoagulation is higher in older patients. In the past, mechanical prosthesis would be preferred for patients younger than 60 years and bioprosthesis would be preferred for patients older than 70 years. However, there is a growing use of bioprosthesis, with the use increasing from approximately 15% to more than 50% in the last 2 decades, particularly in younger patients.2 There remains conflicting evidence regarding the superiority of one type of valve vs the other in patients aged 50 to 70 years. There is now also the availability of transcatheter valve-in-valve replacement for patients who have structural deterioration of a bioprosthetic valve.3