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The ideal valve substitute to replace a diseased aortic valve is a non-thrombogenic, infection-resistant, living autologous valve with excellent haemodynamics and an unlimited durability. Unfortunately, in real life, the available aortic valve substitutes are associated with one or more disadvantages related to their design. The main concern with biological valvular prostheses is their limited durability: in younger patients, in particular, the biological prosthesis may not outlive the patient. Valve degeneration is a slow continuous process. It may cause haemodynamic dysfunction and proneness to prosthetic valve endocarditis, lead to heart failure and possibly death, and in those patients who are managed well by their cardiologist and deemed fit enough to undergo a reintervention it may be decided to replace the degenerated biological prosthesis. Mechanical prostheses, on the other hand, carry the burden of lifelong anticoagulation due to their increased thrombogenicity. Bleeding and thromboembolic event risk depends greatly on patient characteristics, but also on the type and quality of anticoagulation management, which varies widely between countries and continents. In addition, patient outcome after aortic valve replacement is determined by factors that are not related to the implanted valve substitute, like patient comorbidity and country-specific life expectancy. These considerations should be taken into account when assessing the literature on patient …
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