Prosthetic valves

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.