Table 3

Factors Used for Shared Decision Making About Type of Valve Prosthesis

Favor Mechanical ProsthesisFavor Bioprosthesis
Age <50 y
  • Increased incidence of structural deterioration with bioprosthesis (15-y risk: 30% for age 40 y, 50% for age 20 y)

  • Lower risk of anticoagulation complications

Age >70 y
  • Low incidence of structural deterioration (15-y risk: <10% for age >70 y)

  • Higher risk of anticoagulation complications

Patient preference (avoid risk of reintervention)Patient preference (avoid risk and inconvenience of anticoagulation and absence of valve sounds)
Low risk of long-term anticoagulationHigh risk of long-term anticoagulation
Compliant patient with either home monitoring or close access to INR monitoringLimited access to medical care or inability to regulate VKA
Other indication for long-term anticoagulation (e.g., AF)Access to surgical centers with low reoperation mortality rate
High-risk reintervention (e.g., porcelain aorta, prior radiation therapy)
Small aortic root size for AVR (may preclude valve-in-valve procedure in future).

AF indicates atrial fibrillation; AVR, aortic valve replacement; INR, International Normalized Ratio; and VKA, vitamin K antagonist.