Controversy pro: Mechanical AVR for better long-term survival of 50–70 years old

Phillip G. Rowse, Hartzell V. Schaff

Research output: Contribution to journalReview articlepeer-review


Selection of the most appropriate type of aortic valve prosthesis (mechanical or biologic) for patients 50–70 years of age is a matter of frequent debate. The purpose of this article is to review overlooked concepts and misconceptions in valve-related complications, prosthesis durability, and late survival to aid decision making in contemporary practice. A trend favoring improved long-term survival was found among patients who receive a mechanical prosthesis compared to a biologic substitute. Additionally, an acceptably low rate of long-term valve-related thromboembolism and hemorrhage was found among those with mechanical prostheses. Implantation of a biologic valve substitute did not appear to reduce the risk of thromboembolism, may not eliminate the need for long-term anticoagulation and may be associated with an increased risk of late mortality. These findings may aid providers (and patients) in the preoperative consultation and seem to support consideration of a mechanical heart valve substitute over a biologic valve for patients 50–70 years age.

Original languageEnglish (US)
Pages (from-to)26-30
Number of pages5
JournalProgress in Cardiovascular Diseases
StatePublished - May 1 2022


  • Aortic valve replacement
  • Valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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