Browse the corpus

©2013 UpToDate ® Print Email ACC/AHA guideline summary: Criteria for selection of an aortic valve in patients undergoing aortic valve replacement (AVR) Class I - There is evidence and/or generalagreement for the choice of a mechanical or bioprosthetic valve inpatients undergoing AVR in the following settings •  A mechanical valve in patients who already have a mechanical valve in the mitral or tricuspid position. •  A bioprosthetic valve in patients who will not take or are incapable of taking warfarin or have a major contraindication to warfarin therapy. Class IIa - The weight of evidence oropinion is in favor of the choice of a mechanical or bioprostheticvalve in patients undergoing AVR in the following settings •  A bioprosthesis in patients ≥65 years of age who do not have risk factors for thromboembolism. •  Patient preference can be considered in patients less than 65 years of age: 1. A mechanical valve is reasonable in patients who do not have a contraindication to warfarin therapy. 2. A bioprosthetic valve may be chosen after a detailed discussion of the risks of warfarin therapy compared to the likelihood of repeat valve replacement in the future. •  A homograft when aortic valve re-replacement is performed for active prosthetic valve endocarditis. Class IIb - The weight of evidence oropinion is less well established for the choice of a mechanical orbioprosthetic valve in patients undergoing AVR in the following setting •  A bioprosthesis in women of child-bearing age to avoid the problems associated anticoagulation during pregnancy. Data from Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines 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 (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.