Mechanical versus biological aortic valve replacement strategies

Expert Rev Cardiovasc Ther. 2016;14(4):423-30. doi: 10.1586/14779072.2016.1133293. Epub 2016 Jan 25.


Aortic valve replacement (AVR) is the most frequently performed procedure in valve surgery. The controversy about the optimal choice of the prosthetic valve is as old as the technique itself. Currently there is no perfect valve substitute available. The main challenge is to choose between mechanical and biological prosthetic valves. Biological valves include pericardial (bovine, porcine or equine) and native porcine bioprostheses designed in stented, stentless and sutureless versions. Homografts and pulmonary autografts are reserved for special indications and will not be discussed in detail in this review. We will focus on the decision making between artificial biological and mechanical prostheses, respectively. The first part of this article reviews guideline recommendations concerning the choice of aortic prostheses in different clinical situations while the second part is focused on novel strategies in the treatment of patients with aortic valve pathology.

Keywords: Aortic valve replacement; biological valve prosthesis; mechanical valve prosthesis; novel oral anticoagulants; oral anticoagulation.

Publication types

  • Review

MeSH terms

  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Bioprosthesis*
  • Clinical Decision-Making
  • Comparative Effectiveness Research
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / methods
  • Heart Valve Prosthesis*
  • Humans
  • Practice Guidelines as Topic
  • Prosthesis Design
  • Treatment Outcome