{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:53:32Z","timestamp":1792806812086,"version":"4.5.0"},"reference-count":106,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The mechanical valve was first invented in the 1950s, and since then, a wide variety of prostheses have been developed. Although mechanical valves have outstanding durability, their use necessitates life-long treatment with anticoagulants, which increases the risk of bleeding and thromboembolic events. The current guidelines recommend a mechanical prosthetic valve in patients under 50\u201360 years; however, for patients aged 50\u201370 years, the data are conflicting and there is not a clear-cut recommendation. In recent decades, progress has been made in several areas. First, the On-X mechanical valve was introduced; this valve has a lower anticoagulant requirement in the aortic position. Second, a potential alternative to vitamin K-antagonist treatment, rivaroxaban, has shown encouraging results in small-scale trials and is currently being tested in a large randomized clinical trial. Lastly, an innovative mechanical valve that eliminates the need for anticoagulant therapy is under development. We attempted to review the current literature on the subject with special emphasis on the role of mechanical valves in the current era and discuss alternatives and future innovations.<\/jats:p>","DOI":"10.3390\/jcm13133768","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T11:19:02Z","timestamp":1719487142000},"page":"3768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Mechanical Valves: Past, Present, and Future\u2014A Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-6072","authenticated-orcid":false,"given":"Dror B.","family":"Leviner","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2247-2258","authenticated-orcid":false,"given":"Dana","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel"},{"name":"The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9479-4130","authenticated-orcid":false,"given":"Tom","family":"Ronai","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel"},{"name":"The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erez","family":"Sharoni","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.athoracsur.2023.11.016","article-title":"The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2023 Update on Procedure Data and Research","volume":"117","author":"Kaneko","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_2","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the american college of cardiology\/american heart association joint committee on clinical practice guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_4","first-page":"60","article-title":"The surgical correction of aortic regurgitation preliminary report","volume":"6","author":"Hufnagel","year":"1953","journal-title":"Bull. Georget. Univ. Med. Cent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.athoracsur.2005.02.003","article-title":"Long-term results of the cloth-covered Starr-Edwards ball valve","volume":"80","author":"Shiono","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","first-page":"91","article-title":"Forty-year survival with the Starr-Edwards heart valve prosthesis","volume":"13","author":"Gao","year":"2004","journal-title":"J. Heart Valve Dis."},{"key":"ref_7","first-page":"380","article-title":"Anticoagulant management of patients with mechanical prosthetic valves undergoing non-cardiac surgery: Indications and unresolved issues","volume":"10","author":"Shapira","year":"2001","journal-title":"J. Heart Valve Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2850","DOI":"10.1161\/CIRCULATIONAHA.104.511659","article-title":"Twenty-five-year experience with the Bj\u00f6rk-Shiley convexoconcave heart valve: A continuing clinical concern","volume":"111","author":"Blot","year":"2005","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/S0022-5223(19)39262-1","article-title":"Clinical and hemodynamic results with the St. Jude Medical cardiac valve prosthesis. A three-year experience","volume":"82","author":"Nicoloff","year":"1981","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11239-007-0105-x","article-title":"Anticoagulation for mechanical heart valves: A role for patient based therapy","volume":"25","author":"Emery","year":"2008","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1016\/j.jtcvs.2003.07.005","article-title":"Twenty-year experience with the St Jude Medical mechanical valve prosthesis","volume":"126","author":"Ikonomidis","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/j.jtcvs.2015.02.004","article-title":"Requiem for a good mechanical heart valve: Farewell to the Medtronic Hall valve","volume":"149","author":"Antunes","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1111\/jocs.16499","article-title":"Contemporary trends and in-hospital outcomes of mechanical and bioprosthetic surgical aortic valve replacement in the United States","volume":"37","author":"Hiltner","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2687","DOI":"10.1016\/j.jacc.2020.09.608","article-title":"National trends in mechanical valve replacement in patients aged 50 to 70 years","volume":"76","author":"Alkhouli","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e019929","DOI":"10.1161\/JAHA.120.019929","article-title":"Predictors of Use and Outcomes of Mechanical Valve Replacement in the United States (2008\u20132017)","volume":"10","author":"Alkhouli","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1056\/NEJMoa1613792","article-title":"Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement","volume":"377","author":"Goldstone","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Caus, T., Chabry, Y., Nader, J., Fusellier, J.F., and De Brux, J.L. (2023). EpiCard investigators Trends in SAVR with biological vs. mechanical valves in middle-aged patients: Results from a French large multi-centric survey. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1205770"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chan, J., Dimagli, A., Fudulu, D.P., Sinha, S., Narayan, P., Dong, T., and Angelini, G.D. (2022). Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1077279"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jtcvs.2021.12.047","article-title":"Structural valve degeneration of bioprosthetic aortic valves: A network meta-analysis","volume":"166","author":"Squiers","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1016\/j.athoracsur.2015.10.069","article-title":"Long-Term Durability of Carpentier-Edwards Magna Ease Valve: A One Billion Cycle In Vitro Study","volume":"101","author":"Raghav","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/j.jtcvs.2022.10.023","article-title":"Ten-year clinical and echocardiographic follow-up of third-generation biological prostheses in the aortic position","volume":"167","author":"Francica","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1093\/ejcts\/ezab552","article-title":"Carpentier-Edwards Magna Ease bioprosthesis: A multicentre clinical experience and 12-year durability","volume":"61","author":"Piperata","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/eurheartj\/ehz568","article-title":"Contemporary trends in the management of aortic stenosis in the USA","volume":"41","author":"Alkhouli","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1016\/j.jacc.2020.09.595","article-title":"STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement","volume":"76","author":"Carroll","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1111\/jocs.15546","article-title":"Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta-analysis","volume":"36","author":"Ahmed","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"ezac268","DOI":"10.1093\/ejcts\/ezac268","article-title":"Mechanical versus bioprosthetic valve for aortic valve replacement: Systematic review and meta-analysis of reconstructed individual participant data","volume":"62","author":"Tasoudis","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.athoracsur.2019.10.027","article-title":"Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70","volume":"110","author":"Ahtela","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e13736","DOI":"10.1111\/eci.13736","article-title":"Mechanical aortic valve prostheses offer a survival benefit in 50\u201365 year olds: AUTHEARTVISIT study","volume":"52","author":"Traxler","year":"2022","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.cjca.2021.12.008","article-title":"Mechanical vs. Bioprosthetic Aortic Valve Replacement in Patients Younger Than 70 Years of Age: A Hazard Ratio Meta-analysis","volume":"38","author":"Leviner","year":"2022","journal-title":"Can. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2658","DOI":"10.1093\/eurheartj\/ehv580","article-title":"Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50\u201369 years","volume":"37","author":"Glaser","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ezac073","DOI":"10.1093\/ejcts\/ezac073","article-title":"Biological or mechanical mitral valve replacement in patients 50\u201370 years of age-a propensity-adjusted analysis","volume":"62","author":"Leviner","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.jtcvs.2021.03.033","article-title":"Bioprosthetic versus mechanical mitral valve replacements in patients with rheumatic heart disease","volume":"165","author":"Chen","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/S0735-1097(00)00834-2","article-title":"Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: Final report of the Veterans Affairs randomized trial","volume":"36","author":"Hammermeister","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1136\/heart.89.7.715","article-title":"Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses","volume":"89","author":"Oxenham","year":"2003","journal-title":"Heart"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1016\/j.jacc.2009.07.032","article-title":"Aortic valve replacement: A prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years","volume":"54","author":"Stassano","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1001\/jama.2014.12679","article-title":"Survival and long-term outcomes following bioprosthetic vs. mechanical aortic valve replacement in patients aged 50 to 69 years","volume":"312","author":"Chiang","year":"2014","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.athoracsur.2015.10.092","article-title":"Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis","volume":"102","author":"Zhao","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1016\/j.jtcvs.2013.12.042","article-title":"Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: A propensity-matched analysis","volume":"148","author":"McClure","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/j.jtcvs.2020.11.181","article-title":"Members of the Cleveland Clinic Aortic Valve Center Similar long-term survival after isolated bioprosthetic versus mechanical aortic valve replacement: A propensity-matched analysis","volume":"164","author":"Attia","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/ejcts\/ezy459","article-title":"Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50\u201365 years: The ANDALVALVE study","volume":"55","author":"Adsuar","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jtcvs.2021.01.118","article-title":"SPAVALVE Study Group Biological versus mechanical prostheses for aortic valve replacement","volume":"165","author":"Berastegui","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1001\/jama.2015.3164","article-title":"Survival and outcomes following bioprosthetic vs. mechanical mitral valve replacement in patients aged 50 to 69 years","volume":"313","author":"Chikwe","year":"2015","journal-title":"JAMA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.athoracsur.2013.05.014","article-title":"Mechanical prosthesis is reasonable for mitral valve replacement in patients approximately 65 years of age","volume":"96","author":"Nishida","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jtcvs.2017.08.018","article-title":"Survival and long-term outcomes after mitral valve replacement in patients aged 18 to 50 years","volume":"155","author":"Schnittman","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"ezad308","DOI":"10.1093\/ejcts\/ezad308","article-title":"Revisiting aortic valve prosthesis choice in patients younger than 50 years: 10 years results of the AUTHEARTVISIT study","volume":"65","author":"Traxler","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1136\/heartjnl-2017-312047","article-title":"Contemporary outcomes in reoperative mitral valve surgery","volume":"104","author":"Mehaffey","year":"2018","journal-title":"Heart"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jtcvs.2018.03.126","article-title":"Outcomes of repeat mitral valve replacement in patients with prior mitral surgery: A benchmark for transcatheter approaches","volume":"156","author":"Ejiofor","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.athoracsur.2015.04.062","article-title":"Contemporary Outcomes of Repeat Aortic Valve Replacement: A Benchmark for Transcatheter Valve-in-Valve Procedures","volume":"100","author":"Kaneko","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.athoracsur.2022.12.045","article-title":"Risk factors and outcomes of reoperative surgical aortic valve replacement in the United Kingdom","volume":"116","author":"Narayan","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.jtcvs.2022.02.052","article-title":"The decreasing risk of reoperative aortic valve replacement: Implications for valve choice and transcatheter therapy","volume":"166","author":"Mahboubi","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1161\/01.CIR.89.2.635","article-title":"Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses","volume":"89","author":"Cannegieter","year":"1994","journal-title":"Circulation"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/S0735-1097(10)80178-0","article-title":"Obstruction of mechanical heart valve prostheses: Clinical aspects and surgical management","volume":"17","author":"Deviri","year":"1991","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.jtcvs.2003.12.013","article-title":"Prosthetic valve thrombosis: Twenty-year experience at the Montreal Heart Institute","volume":"127","author":"Pellerin","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJM199507063330103","article-title":"Optimal oral anticoagulant therapy in patients with mechanical heart valves","volume":"333","author":"Cannegieter","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1378\/chest.08-1233","article-title":"Achieved anticoagulation vs. prosthesis selection for mitral mechanical valve replacement: A population-based outcome study","volume":"136","author":"Lim","year":"2009","journal-title":"Chest"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1161\/CIRCULATIONAHA.119.041105","article-title":"How did we get here?: A historical review and critical analysis of anticoagulation therapy following mechanical valve replacement","volume":"140","author":"MacIsaac","year":"2019","journal-title":"Circulation"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1056\/NEJM199002153220703","article-title":"Trial of different intensities of anticoagulation in patients with prosthetic heart valves","volume":"322","author":"Saour","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0022-5223(19)36724-8","article-title":"Comparison of two levels of anticoagulant therapy in patients with substitute heart valves","volume":"101","author":"Altman","year":"1991","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1161\/01.CIR.94.9.2107","article-title":"AREVA: Multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves","volume":"94","author":"Acar","year":"1996","journal-title":"Circulation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ahj.2010.05.005","article-title":"LOWERing the INtensity of oral anticoaGulant Therapy in patients with bileaflet mechanical aortic valve replacement: Results from the \u201cLOWERING-IT\u201d Trial","volume":"160","author":"Torella","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.jtcvs.2014.01.004","article-title":"Reduced anticoagulation after mechanical aortic valve replacement: Interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial","volume":"147","author":"Puskas","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1161\/01.CIR.72.5.1059","article-title":"Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: A prospective randomized clinical trial","volume":"72","author":"Mok","year":"1985","journal-title":"Circulation"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Little, S.H., and Massel, D.R. (2003). Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst. Rev., CD003464.","DOI":"10.1002\/14651858.CD003464"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.jacc.2018.03.535","article-title":"Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic Valve Replacement","volume":"71","author":"Puskas","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1056\/NEJMoa1300615","article-title":"Dabigatran versus warfarin in patients with mechanical heart valves","volume":"369","author":"Eikelboom","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"EVIDoa2300067","DOI":"10.1056\/EVIDoa2300067","article-title":"Apixaban or Warfarin in Patients with an On-X Mechanical Aortic Valve","volume":"2","author":"Wang","year":"2023","journal-title":"NEJM Evid."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s40256-020-00449-3","article-title":"Rivaroxaban Versus Warfarin in Patients with Mechanical Heart Valves: Open-Label, Proof-of-Concept trial-The RIWA study","volume":"21","author":"Duraes","year":"2021","journal-title":"Am. J. Cardiovasc. Drugs"},{"key":"ref_68","first-page":"80","article-title":"The On-X heart valve: Mid-term results in a poorly anticoagulated population","volume":"15","author":"Williams","year":"2006","journal-title":"J. Heart Valve Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.athoracsur.2022.12.031","article-title":"Low-Dose vs. Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Trial","volume":"115","author":"Chu","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jtcvs.2021.04.011","article-title":"Late results of aortic valve repair for isolated severe aortic regurgitation","volume":"165","author":"Tamer","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.jtcvs.2010.02.035","article-title":"Repair of the bicuspid aortic valve: A viable alternative to replacement with a bioprosthesis","volume":"139","author":"Ashikhmina","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/ejcts\/ezab176","article-title":"Bicuspid aortic valve repair: Outcomes after 17 years of experience","volume":"60","author":"Jasinski","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.jtcvs.2014.02.010","article-title":"Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: A propensity score analysis","volume":"148","author":"Pasquet","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.athoracsur.2023.07.051","article-title":"Aortic Valve Repair Results in Better 1-Year Survival Than Replacement: Results from German Aortic Valve Registry","volume":"117","author":"Girdauskas","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.athoracsur.2021.06.020","article-title":"Aortic Valve Repair Decreases Risks of VRE in AI at 10 Years: A Propensity Score-Matched Analysis","volume":"113","author":"Jabagi","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1111\/jocs.16473","article-title":"Valve-sparing versus valve-replacing aortic root replacement in patients with aortic root aneurysm","volume":"37","author":"Malaisrie","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jtcvs.2015.10.068","article-title":"Long-term outcomes of aortic root operations for Marfan syndrome: A comparison of Bentall versus aortic valve-sparing procedures","volume":"151","author":"Price","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"ezac283","DOI":"10.1093\/ejcts\/ezac283","article-title":"Aortic valve repair versus mechanical valve replacement for root aneurysm: The CAVIAAR multicentric study","volume":"62","author":"Lansac","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Ehrlich, T., Abeln, K.B., Froede, L., Burgard, C., Giebels, C., and Sch\u00e4fers, H.-J. (J. Thorac. Cardiovasc. Surg., 2023). Valve-sparing aortic root replacement-for all patients?, J. Thorac. Cardiovasc. Surg., in press.","DOI":"10.1016\/j.jtcvs.2023.08.055"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Sharma, V.J., Kangarajah, A., Yang, A., Kim, M., Seevayanagam, S., and Matalanis, G. (J. Thorac. Cardiovasc. Surg., 2023). Valve-sparing aortic root replacement: Long-term variables significantly associated with mortality and morbidity, J. Thorac. Cardiovasc. Surg., in press.","DOI":"10.1016\/j.jtcvs.2023.11.027"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"570","DOI":"10.21037\/acs.2017.11.06","article-title":"Systematic review and meta-analysis of surgical outcomes in Marfan patients undergoing aortic root surgery by composite-valve graft or valve sparing root replacement","volume":"6","author":"Flynn","year":"2017","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1016\/j.jacc.2016.07.767","article-title":"Valve-Sparing Root Replacement Compared with Composite Valve Graft Procedures in Patients with Aortic Root Dilation","volume":"68","author":"Ouzounian","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jtcvs.2018.10.059","article-title":"Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection","volume":"157","author":"Rosenblum","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.jacc.2018.01.048","article-title":"Improved survival after the ross procedure compared with mechanical aortic valve replacement","volume":"71","author":"Buratto","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.tcm.2022.06.005","article-title":"Long-Term Outcomes of Ross Procedure versus Mechanical Aortic Valve Replacement: Meta-Analysis of Reconstructed Time-To-Event Data","volume":"34","author":"Jacquemyn","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.jacc.2021.11.057","article-title":"Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in Adults","volume":"79","author":"Toyoda","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/ejcts\/ezac013","article-title":"Ross procedure provides survival benefit over mechanical valve in adults: A propensity-matched nationwide analysis","volume":"61","author":"Gofus","year":"2022","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2761","DOI":"10.1016\/j.jacc.2018.08.2200","article-title":"Ross Procedure in Adults for Cardiologists and Cardiac Surgeons: JACC State-of-the-Art Review","volume":"72","author":"Mazine","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1161\/CIRCULATIONAHA.116.022800","article-title":"Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement: Propensity-Matched Cohort Study","volume":"134","author":"Mazine","year":"2016","journal-title":"Circulation"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1001\/jamacardio.2018.2946","article-title":"Ross Procedure vs. Mechanical Aortic Valve Replacement in Adults: A Systematic Review and Meta-analysis","volume":"3","author":"Mazine","year":"2018","journal-title":"JAMA Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Stolte, T., Boeddinghaus, J., Allegra, G., Leibundgut, G., Reuthebuch, O., Kaiser, C., M\u00fcller, C., and Nestelberger, T. (2023). Incidence and Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Valves. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185868"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.amjcard.2022.01.049","article-title":"Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement","volume":"171","author":"Demal","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.jcin.2019.10.030","article-title":"Transcatheter ViV Versus Redo Surgical AVR for the Management of Failed Biological Prosthesis: Early and Late Outcomes in a Propensity-Matched Cohort","volume":"13","author":"Tam","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1093\/eurheartj\/ehaa544","article-title":"Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves","volume":"41","author":"Bleiziffer","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1161\/CIRCULATIONAHA.116.023340","article-title":"Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry","volume":"135","author":"Lazam","year":"2017","journal-title":"Circulation"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.amjcard.2018.10.024","article-title":"Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for Degenerative Mitral Regurgitation Across All Ages","volume":"123","author":"Jung","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ejcts.2006.11.014","article-title":"Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement","volume":"31","author":"Shuhaiber","year":"2007","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/eurheartj\/ehy590","article-title":"Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification","volume":"40","author":"Yoon","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1161\/CIRCULATIONAHA.120.049088","article-title":"Transcatheter Mitral Valve Replacement after Surgical Repair or Replacement: Comprehensive Midterm Evaluation of Valve-in-Valve and Valve-in-Ring Implantation from the VIVID Registry","volume":"143","author":"Simonato","year":"2021","journal-title":"Circulation"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.amjcard.2022.11.043","article-title":"Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated Bioprosthetic Mitral Valve","volume":"189","author":"Ismayl","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"f20","DOI":"10.1093\/ehjcvp\/pvz073","article-title":"Safety and efficacy of non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: Systematic review and meta-analysis of 22 studies and 440\u2009281 patients","volume":"7","author":"Silverio","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.xjon.2021.05.011","article-title":"Aortic valve replacement in sheep with a novel trileaflet mechanical heart valve prosthesis without anticoagulation","volume":"7","author":"Schaller","year":"2021","journal-title":"JTCVS Open"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/icvts\/ivy337","article-title":"A novel trileaflet mechanical heart valve: First in vitro results","volume":"28","author":"Schubert","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Carrel, T., Vogt, P.R., Obrist, D., and Schaff, H. (2023). Evolving technology: The TRIFLO tri-leaflet mechanical valve without oral anticoagulation: A potential major innovation in valve surgery. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1220633"},{"key":"ref_106","first-page":"791","article-title":"In-vivo experience with the Triflo trileaflet mechanical heart valve","volume":"15","author":"Gallegos","year":"2006","journal-title":"J. Heart Valve Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/13\/3768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:06:24Z","timestamp":1760108784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/13\/3768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":106,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["jcm13133768"],"URL":"https:\/\/doi.org\/10.3390\/jcm13133768","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,27]]}}}