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35.9 Prosthetic valves
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Published:July 2018
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This version:November 2024
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Abstract
Prosthetic valve replacement is the most frequent valvular surgery. The choice between a mechanical prosthesis and a bioprosthesis should not overstress the role of age, and should take into account in particular the wishes of the informed patient. Patients with a mechanical prosthesis require lifelong treatment using VKA with a target INR adapted to the prosthesis and patient characteristics, while non-vitamin K antagonist oral anticoagulants are contra-indicated. The association of low-dose aspirin is restricted to selected patients with a mechanical prosthesis who have atherosclerosis or recurrent embolism. The post-operative period is at risk of thromboembolism and bleeding and requires increased awareness on the monitoring of anticoagulant therapy. The management of anticoagulant therapy during non-cardiac surgery should be adapted to the type of surgery. Minor procedures generally do not require interruption of anticoagulation. Dual antiplatelet therapy is recommended after transcatheter aortic valve implantation but ongoing trials will probably refine antithrombotic regimen.
Update:
Chapter has been extensively updated to reflect the 2021 ESC/EACTS Guidelines for the management of valvular heart disease
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