Selection of prosthetic heart valves.

Cardiovascular surgery for the repair or replacement of diseased heart valves has continually improved since its introduction in the early 1960s. Despite advances in prosthetic heart valve design, to date there is no valve that is comparable to the native human valve with respect to durability, risk of thrombosis, and overall hemodynamic function. Although bioprosthetic devices are similar to the native valve with respect to thrombogenicity, durability is a significant concern, particularly in younger patients. Approximately 45% of implanted bioprosthetic valves fail at 10 years. In contrast, mechanical prostheses have a significantly lower incidence of structural failure, with an implantation life of greater than 20 years, and are thus more often used for patients under the age of 65. Unfortunately, significant hemodynamic and thrombotic issues have yet to be resolved with the latest generation of mechanical valves. Thus, careful analysis of patient factors and valve-related complications must be considered when treatment of heart valve disease is offered to the patient. The purpose of this review is to discuss the current recommendations for surgical intervention for heart valve disease.