Dimarakis et al1 present data from patients aged ≥65 years who had mitral valve replacement (MVR)±coronary artery bypass graft±concomitant tricuspid valve repair from 2001 to 2011. Data are largely from NHS hospitals in England and Wales. There were 3862 patients from 33 hospitals.

The three goals of the study and the findings are straightforward: Goal 1 was to determine the per cent of patients in clinical practice in the UK aged ≥65 years who have a mechanical or bioprosthetic mitral prosthetic heart valve (PHV). Approximately 50% received a mechanical and 50% received a bioprosthetic PHV. However, there was considerable variation between hospitals with respect to the choice of PHV. Goal 2 was to establish if the guidelines2 ,3 are being followed? The two guidelines give a Class II recommendation for use of a bioprosthesis in those aged ≥65 years2 and >70 years.3 This is obviously not being followed in clinical practice. However, there was an increasing trend to use a bioprosthesis with time (28.2% in 2001–2002 to 69.0% in 2010–2011) and for increasing age (29.6% in those aged 65–70 years to 79% in those aged ≥80 years). Goal 3 was to determine whether the guidelines were appropriate? This was evaluated on the …