Recommendations for prosthetic valve choice

Recommendations	COR	LOE
Choice of valve intervention and prosthetic valve type should be a shared decision process	I	C
A bioprosthesis is recommended in patients of any age for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired	I	C
A mechanical prosthesis is reasonable for AVR or MVR in patients <60 years of age who do not have a contraindication to anticoagulation	IIa	B
A bioprosthesis is reasonable in patients >70 years of age	IIa	B
Either a bioprosthetic or mechanical valve is reasonable in patients between 60 and 70 years of age	IIa	B
Replacement of the aortic valve by a pulmonary autograft (the Ross procedure), when performed by an experienced surgeon, may be considered in young patients when VKA anticoagulation is contraindicated or undesirable	IIb	C

COR: class of recommendation; LOE: level of evidence; AVR: aortic valve replacement; MVR: mitral valve replacement; VKA: vitamin K antagonist.

Reproduced from: Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57. Table used with the permission of Elsevier Inc. All rights reserved.

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Recommendations for prosthetic valve choice