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Bioprosthetic Valve Selection — RACP Adult Medicine MCQ

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ModerateCardiologyBioprosthetic Valve SelectionRACP Adult Medicine

A 55-year-old woman with no AF and no indication for anticoagulation requires mitral valve replacement (MV repair not feasible). She is active and wants to avoid blood thinners. She has a life expectancy of >20 years. What is the most appropriate valve prosthesis?

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Correct answer: C — Bioprosthetic (tissue) valve

A 55-year-old woman who wants to avoid anticoagulation with >20-year life expectancy — bioprosthetic valve avoids lifelong warfarin. Modern bioprosthetic valves have improved durability (15-20+ years, especially in the mitral position in patients >50). Future valve-in-valve TAVI is available if the bioprosthetic degenerates. The trade-off: potential redo surgery vs lifelong anticoagulation risk. Shared decision-making with the patient is essential.

Reference: CSANZ – 2024 – VHD; ESC 2021 VHD