A devilish dilemma

CLINICAL PROBLEM
For aortic valve replacement (AVR), two types of valve substitutes are available: mechanical and bioprosthetic valves. Mechanical valves are designed to last a lifetime but require lifelong anticoagulation, resulting in an increased bleeding risk. Bioprostheses do not require long-term anticoagulation, unless another indication is present. However, they are subject to valve deterioration over time, and patients may require one or more reoperations later in life. Given the different nature of these risks and benefits for mechanical and bioprosthetic valves, informed patient preferences deserve consideration in decision-making. In some patients, the choice is complex.