Choice of Mechanical Versus Bioprosthetic AVR Recommendations for Choice of Mechanical Versus Bioprosthetic AVR Referenced studies that support the recommendations are summarized in Online Data Supplements 11 and 12. COR LOE Recommendations In patients with an indication for AVR, the choice of prosthetic valve should be based on a shared decision-making process that accounts for the patient s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risks associated with valve reintervention. For patients of any age requiring AVR for whom VKA anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired, a bioprosthetic AVR is recommended. For patients <50 years of age who do not have a contraindication to anticoagulation and require AVR, it is reasonable to choose a mechanical aortic prosthesis over a For patients 50 to 65 years of age who require AVR and who do not have a contraindication to anticoagulation, it is reasonable to individualize the choice of either a mechanical or bioprosthetic AVR with consideration of individual patient factors and after informed In patients >65 years of age who require AVR, it is reasonable to choose a bioprosthesis over a mechanical valve.1 In patients <50 years of age who prefer a bioprosthetic AVR and have appropriate anatomy, replacement of the aortic valve by a pulmonic autograft (the Ross procedure) may be considered at a Comprehensive Valve Synopsis Shared decision-making about the choice of pros- thetic valve type is influenced by several factors, CLINICAL STATEMENTS AND GUIDELINES including patient age, values, and preferences; ex- pected bioprosthetic valve durability, avoidance of pa- tient prosthesis mismatch, and the potential need for and timing of reintervention; and the risks associated with long-term VKA anticoagulation with a mechani- cal valve replacement. 