IJCS | Volume 33, Nº1, January / February 2019

DOI: https://doi.org/10.36660/ijcs.20190202 1 The 2017 European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC/EACTS3) guidelines established that the choice between a mechanical (MV) and biological valve (BV) in adults is primarily determined by estimating the risk of bleeding related to anticoagulation, thromboembolism, and the risk of structural deterioration of BV, considering the patient’s lifestyle and preferences. 2 This risk/benefit ratio of MV and BV led the US and European guidelines to recommend the use of prostheses in patients under 60 years of age. Nevertheless, the use of BV has increased significantly in all age groups in recent decades. 2 The recently published paper entitled “Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life” 3 assessed the quality of life (QoL) using the short form (SF)-36 questionnaire of 36 consecutive patients (16 men), mean age 51 years, who underwent heart valve replacement. After an average time of 32.5 months, the study showed that the type of prosthesis did not seem to influence patients’ QoL. Also, another study on QoL (SF-36) included 121 consecutive patients undergoing BV (76.5%) andMV (86,3,1%). No significant differences were found between valve groups for any aspects of QoL. 4 Kottmaier et al., 5 compared QoL and anxiety of 56 patients after mechanical aortic valve replacement (AVR) (mean age: 64.4 ± 8.17 years) and 66 patients after biological AVR (mean age: 64.8 ± 11.05 years. After 5.66 (± 2.68) years of surgery, patients received the SF-36 to assess QOL, the fear of progression questionnaire (FOP), and the cardiac anxiety questionnaire (CAQ) to assess general anxiety. No significant differences were found for all categories of the SF-36. The FOP showed significantly favorable values for the biological AVR group. The CAQ showed a tendency towards more favorable values in the subscales “avoid” (i.e, avoid pulse increase) and “attention” for the biological AVR group. 5 A systematic review and meta-analysis were performed to compare long-term survival, major prosthetic-related events, anticoagulant-related events, major bleeding, reoperation, and structural valve degeneration in middle-aged patients who received BV or MV. Results from patients under 70 years of age undergoing AVR with BV or MV were included. A total of 12 studies involving 8,661 patients was analyzed. There was no significant difference in long-term survival between patients 50 to 70 or 60 to 70 years. BV patients had significantly fewer long-term anticoagulant-related events. Also, studies have supported the use of BV in patients over 60 years of age. 6 In this sense, scientific progress may increase the acceptance level for conservative aortic valve surgery using bovine pericardium valve (BPV). One study reported a long-term follow-up (23 years) of a patient who underwent surgery on the BPV cusp extension. 7 34 EDITORIAL International Journal of Cardiovascular Sciences. 2020;33(1):34-35 Mailing Address: Idiberto José Zotarelli Filho Rua Luiz Vaz de Camões, 3111. Postal Code: 15015-750, Vila Redentora, São José do Rio Preto, SP - Brazil. E-mail: m.zotarelli@gmail.com Biological and Mechanical Heart Valves Under a New Spotlight: Paradigm Shift and New State of the Art Domingo Marcolino Braile 1, 2 a nd Idiberto José Zotarelli Filho 1 Domingo Braile Institute of São José do Rio Preto (SP), 1 São José do Rio Preto, SP - Brazil Braile Biomédica, 2 São José do Rio Preto, SP - Brazil Heart Valve Diseases/surgery; Heart Valve Prosthesis Implantation/methods;Trancathter Aortic Valve Replacement (TAVR)/methods; Minimally Invasive Surgical Procedures/trends. Keywords