Biological and Mechanical Heart Valves Under a New Spotlight: Paradigm Shift and New State of the Art

With the growth in life expectancy observed in recent decades in Brazil and worldwide, implantation of cardiac valve prostheses has been one of the recommended procedures for patients with valve diseases. In Brazil, this approach is the second most performed surgery among highly complex cardiovascular procedures. According to DATASUS, between January 2008 and May 2018, 900 implants were performed.

The 2017 European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC/EACTS3) guidelines established that the choice between a mechanical (MV) and biological valve (BV) in adults is primarily determined by estimating the risk of bleeding related to anticoagulation, thromboembolism, and the risk of structural deterioration of BV, considering the patient’s lifestyle and preferences. This risk/benefit ratio of MV and BV led the US and European guidelines to recommend the use of prostheses in patients under 60 years of age. Nevertheless, the use of BV has increased significantly in all age groups in recent decades.

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