Matching the patient to the type of heart valve substitute can be challenging because there is no evidence that the type of heart valve implanted affects survival or quality of life. Mechanical valves are more durable than bioprosthetic valves but are more thrombogenic and require lifelong anticoagulation with warfarin. Age is the most important determinant of bioprosthetic heart valves' durability, and they infrequently fail in patients older than 70 years of age and almost invariably fail in patients younger than 50 years of age. Thus, patients younger than 50 years of age should be advised to have a mechanical valve unless there is contraindication to anticoagulation with warfarin. Patients 50 to 70 years of age can have either bioprosthetic or mechanical valves, but if their lifespans are greater than 20 years, they will likely require reintervention. In reality, the proportion of patients receiving bioprosthetic heart valves has increased in patients of all ages during the past 2 decades, and this trend preceded the development of transcatheter valve implantation to treat failed bioprosthetic valves. Transcatheter valve-in-valve replacement is now the preferred treatment for failed bioprosthetic valves in all positions in older patients, but the long-term results of this approach remain unknown. The shift in favour of bioprosthetic valves in young patients may prove harmful, as more long-term data become available.
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