With prosthetic valve stenosis, TTE diagnosis while the patient is asymptomatic alerts the clinician to the need for more frequent follow-up. A standardized definition and grading system for structural valve deterioration for sur- gical and transcatheter aortic valves have been In patients with mechanical valve prostheses, routine annual TTE evaluation is not needed if the postoperative baseline study is nor- mal and no clinical change is apparent. Many of these patients require TTE studies for other indi- cations, however, such as for the assessment of LV function, pulmonary artery pressure, or other cardiac or valve disease. 5. Durability data for bioprosthetic TAVI valves are less robust than the data for surgically implanted bioprosthetic valves. To date, the intermediate- term durability of TAVI valves has compared favorably with that of SAVR valves, as reported in randomized trials and registries.14 21 For the most part, these data reflect observations made in older patients and may not be applicable to younger populations (eg, <70 years). TAVI-based protocols typically include routine TTE before dis- charge and at 30 days and 1 year, in part because of reporting requirements. In the absence of clini- cal change, routine annual TTE studies are reason- able as experience continues to accumulate. 11.1.2. Selection of Prosthetic Valve Type: Bioprosthetic Versus Mechanical Valve Recommendations for Prosthetic Valve Type: Bioprosthetic Versus Mechanical Valve Referenced studies that support the recommendations are summarized in Online Data Supplement 35. COR LOE Recommendations For patients who require heart valve replacement, 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. 