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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Criteria for selection of a mitral valve in patients undergoing mitral valve replacement (MVR) Class I - There is evidence and/or generalagreement for the choice of a mechanical or bioprosthetic valve inpatients undergoing MVR in the following setting •  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 MVR in the following settings •  A bioprosthesis in patients ≥65 years of age who do not have risk factors for thromboembolism. •  Among patients less than 65 years of age: 1. A mechanical valve in patients with long-standing atrial fibrillation. 2. A bioprosthetic valve may be chosen in patients in sinus rhythm who elect this valve for lifestyle considerations after a detailed discussion of the risks of warfarin therapy compared to the likelihood of repeat MVR in the future. 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.