Recommendations for valve replacement with a mechanical prosthesis | Class |
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1. Patients with expected long life spans | I |
2. Patients with a mechanical prosthetic valve already in place in a different position than the valve to be replaced | I |
3. Patients in renal failure, on haemodialysis, or with hypercalcaemia | II |
4. Patients requiring warfarin treatment because of risk factors* for thromboembolism | IIa |
5. Patients ≤65 years for AVR and ≤70 years for MVR | IIa |
Recommendations for valve replacement with a bioprosthesis | |
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Class I There is evidence and/or general agreement that a given procedure or treatment is useful and effective. | |
Class II There is conflicting evidence and/or a disagreement of opinion about the usefulness/efficacy of a procedure or treatment. | |
Class IIa Weight of evidence/opinion is in favour of usefulness/efficacy. | |
Class IIb Usefulness/efficacy is less well established by evidence/opinion. | |
*Risk factors: atrial fibrillation, severe left ventricular dysfunction, previous thromboembolism, and hypercoagulable condition. | |
AVR, aortic valve replacement; MVR, mitral valve replacement. | |
1. Patients who cannot or will not take warfarin treatment | I |
2. Patients ≥65 years needing AVR who do not have risk factors for thromboembolism* | I |
3. Patients considered to have possible compliance problems with warfarin treatment | IIa |
4. Patients >70 years needing MVR who do not have risk factors for thromboembolism* | IIa |
5. Valve rereplacement for thrombosed mechanical valve | IIb |