• heart valve replacement
• mechanical prosthesis
• bioprosthesis
• elderly

• BP, bioprosthesis
• INR, international normalised ratio
• MP, mechanical prosthesis
• VA, Veterans Affairs

Prosthetic valve replacement has transformed the prognosis of major and poorly tolerated valvulopathies. The respective advantages and disadvantages of the two types of valves available are well known: mechanical prostheses (MP) theoretically have an indeterminate life span but carry the risk of thromboembolic events that require anticoagulant therapy, which itself is responsible for haemorrhages; bioprostheses (BP), free of anticoagulant treatment and thus haemorrhagic risk, bear a theoretically lower thromboembolic risk (but in fact equal to that of an anticoagulated MP) and have a limited life span that requires reintervention at a subsequent date influenced by the patient’s age at implantation, the valve replaced, and the BP type used.

These respective risks affect the long term outcome of the prosthesis bearer and differ by their time of occurrence. Thromboembolic and haemorrhagic events can occur at any time during the postoperative period, whereas BP deterioration, highly unusual during the first few years after implantation, can occur as early as the 10th year or even earlier, especially in patients younger at the time of surgery and those with mitral valvulopathy, and is seen in almost all patients by 20 years.

The indication for a BP must take into account the contraindications for anticoagulants, the patient’s informed consent, and his/her life expectancy at the time of the intervention. This latter essential factor explains the preference for an MP before 60 years and a BP after 70 years. However, a consensus has not yet been reached for the seventh decade, between 60 and 70 years, even though the American College …