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What type of heart valve is better for middle-age people having AVR?

Middle-age people (aged 40 to 70 years) undergoing aortic valve replacement (AVR) should strongly consider tissue-based heart valves over metal-based heart valves because they may fare better with tissue-based valves rather than metal-based valves.

Researchers evaluated 13 studies comparing mechanical valves and bioprosthetic valves in middle-age people undergoing AVR. At 15-years post-surgery, the researchers found no difference in survival, stroke rate, or rate of endocarditis (infection of the heart lining) among people with either valve; however, each group showed different complications. People with bioprosthetic valves were twice as likely as people with mechanical valves to need re-operation because of worn-out valves, while people with mechanical valves were twice as likely to experience a major bleeding event or a blood clot.

Because people with major bleeding had a significant increase of death compared to those needing reoperation, the researchers said bioprosthetic valves should strongly be considered for people in this age group, though valve choice should be individualized for each person.

The choice of valve is a complex decision that requires up-to-date evidence. There are options to reduce the bleeding risk of mechanical valves, so, ideally, a discussion with both the surgeon and cardiologist is warranted to take into account an individual’s circumstances.

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