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Choice of prosthetic heart valve for surgical aortic or mitral valve replacement

William H Gaasch, MD
Rakesh M Suri, MD, DPhil
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


When heart valve replacement is warranted, a choice is made between transcatheter valve replacement and surgical valve replacement with a mechanical or bioprosthetic valve.

Choice of prosthesis for surgical valve replacement will be reviewed here. The discussion will focus on aortic or mitral valve replacement. The indications for valve replacement, assessment of risk of valve surgery, complications of prosthetic valves, management of patients with prosthetic valves, and choice of valve intervention prior to pregnancy are discussed separately. (See "Indications for valve replacement in aortic stenosis in adults" and "Natural history and management of chronic aortic regurgitation in adults" and "Medical management and indications for intervention for mitral stenosis", section on 'Indications for intervention' and "Management of chronic primary mitral regurgitation" and "Estimating the mortality risk of valvular surgery" and "Diagnosis of mechanical prosthetic valve thrombosis or obstruction" and "Overview of the management of patients with prosthetic heart valves" and "Pregnancy and valve disease", section on 'Interventions prior to pregnancy' and "Management of chronic primary mitral regurgitation", section on 'Indications for mitral valve intervention'.)


Surgical valve replacement is performed with mechanical or bioprosthetic valves. For most patients, a choice is made between a mechanical valve or a stented bioprosthesis [1,2]:

Current mechanical options include bileaflet (eg, St. Jude, Carbomedics, and On-X valves) and low thrombogenicity single tilting disc valves (eg, Medtronic Hall).

Some earlier mechanical valve types were associated with greater risk of complications. Some studies have suggested that earlier tilting disc valve types (eg, Omniscience, Lillehei-Kaster, Bjork-Shiley Monostrut) were associated with increased risk of thromboembolism [1]. The earlier Bjork-Shiley convexo-concave single tilting disc valve was withdrawn from the market in 1986 due to reports of outlet strut fractures. The older caged ball valve (eg, Starr-Edwards) had unfavorable hemodynamic qualities and posed a high risk of thromboembolism and is no longer implanted.

Bioprosthetic valve options include pericardial and xenograft (porcine, bovine, or equine) valves. Pericardial and xenograft valves may be stented or stentless. Bioprosthetic aortic valve options also include aortic homografts and the Ross procedure (pulmonary autograft in the aortic position). Stented bioprosthetic valves are the most common bioprosthetic option. (See 'Comparison of bioprosthetic valves' below.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 01, 2017.
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