Impact of valve in valve aortic valve implantation in valve choice decision making.

To the Editor, I read with interest the excellent study of Kim and his colleagues to compare the clinical outcome of long term survival in patients aged 50–69 years old who underwent isolated aortic valve replacement with mechanical versus bioprosthetic valves. The study showed no significant difference in cardiac mortality‐ free survival and long‐term survival rates between the two valves. Valves choice decision making was and still a constant dilemma since the adventure of those two types of valves. Eventually it is dependent on patient related factors and patient choice. Mechanical valves are associated with increase risk of anticoagulation related hemorrhage and thromboembolism. It also requires frequent coagulation monitoring and closer outpatient follow up. Degeneration and calcification causing valve dysfunction and requiring reoperation are the main concern with bioprosthesis. Currently, the swift advances in transcatheter procedures changed the future of cardiac surgery. Transcatheter aortic valve implantation and valve in valve aortic valve implantation are recently introduced interventional procedures and proved to be a reasonable therapeutic option for high risk and moderate risk patients avoiding resternotomy and comorbidities of surgical aortic valve replacement. These new interventional advances in catheter valve procedures affected the decisions making in valve choice and tilted the cuff and the scale in favor of bioprosthesis. Khaled E. Al‐Ebrahim FRCSC