6th May 2025

Choosing between valve types

Transcatheter valves are used less commonly, and typically only in the aortic and occasionally in the pulmonary position. In the aortic position TAVR is typically preferred if patients are >75 years or unsuitable for SAVR due to comorbidities or surgical risk, while SAVR is preferred if <75 years or low surgical risk.

Within surgical replacement, guidelines recommend mechanical prostheses if:

• According to patient preference
• Risk of accelerated valve dysfunction – young patients <40, hyperparathyroidism, dialysis patients
• <60 years for prosthesis in the aortic position, <65 years in the mitral position
• Patients for whom redo surgery or future TAVI would be high risk

Bioprosthetic valves are recommended if:

• According to patient preference
• Anticoagulation adherence is likely to be poor or contraindicated – typically due to high bleeding risk
• Young women considering pregnancy due to the teratogenic nature of vitamin k antagonists
• Life expectancy is lower than the presumed durability of the bioprosthesis
• In case of re-operation for mechanical valve thrombosis despite good anticoagulant adherence
• >65 years in the aortic position or >70 in the mitral position