Currently, a selection of good, albeit not perfect, prosthetic heart valves (PHVs) with data on patient outcomes with follow-up times of 15 to 20 years or longer is available. The “next generation” of PHVs have some interesting features, but there are no data on patient outcomes at ≥15 to 20 years. The history of PHVs is that: 1) major advances have come in small increments, and 2) extrapolations made from early results were not correct at long term, and when this occurred, patients paid the price in terms of mortality and morbidity. Thus, great enthusiasm from early results and premature prediction may be inappropriate. The data on long-term outcomes are needed and in 2003 one should preferentially select a PHV with proven long-term results.
