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Mechanical Valve in AF Patient — RACP Adult Medicine MCQ

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ModerateCardiologyMechanical Valve in AF PatientRACP Adult Medicine

A 70-year-old woman with AF on warfarin requires aortic valve replacement for severe calcific AS. She has multiple comorbidities and is expected to live 10-15 years. She is already on warfarin (INR 2.5). What is the most appropriate valve prosthesis?

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Correct answer: D — Mechanical valve

A 70-year-old already on warfarin for AF — the anticoagulation burden is already present. A mechanical valve provides superior durability (lifelong) versus bioprosthetic (10-15 years, may require redo surgery). Since she is already anticoagulated, the main disadvantage of mechanical valves (need for warfarin) is moot. Mechanical valve is reasonable here. However, many surgeons still prefer bioprosthetic at age 70+ to avoid higher warfarin targets. This is a shared decision.

Reference: CSANZ – 2024 – VHD; ESC 2021 VHD