IJCS | Volume 33, Nº1, January / February 2019

35 Increasing confidence in the effectiveness of the operation has allowed a faster indication for surgical treatment, as is already the case in mitral valve repair. This change of attitude will allow patients with mild aortic valve regurgitation to be referred for surgery, which can positively alter the natural history of aortic valve insufficiency. 7 In the setting of transcatheter AVR (TAVR) as a minimally invasive alternative to surgical AVR (SAVR), Chakravarty et al., 8 aiming to elucidate the greater propensity of using bioprostheses in relation to anticoagulation, evaluated the impact of anticoagulation after aortic valve replacement. Echocardiograms were performed 30 days and 1 year after TAVR. A total of 4,832 patients underwent TAVR (3,889) and SAVR (943). In the short term, early anticoagulation after biological AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics and was associated with decreased rates of stroke after SAVR. In this context, transcatheter valve-in-valve (ViV) implantation has been increasingly used in recent years, especially with BPV. A 2019 study evaluated 30-day and 1-year mortality and the incidence of adverse outcomes in patients receiving ViV or re-SAVR. Despite a higher risk profile in ViV, 30-day and 1-year mortality rates were no different compared to re-SAVR, which may be explained by a higher rate of re-SAVR complications. Therefore, ViV seems to be a safe and viable therapeutic option for patients with degenerated aortic bioprosthesis. 9 Also, two randomized clinical trials have been published, the Evolut Low-Risk study 10 and the PARTNER 3 study compared TAVR and SAVR in patients who are low surgical risk. 11 The mean age in both trials was 74 years. Patients who had undergone TAVR showed lower rate of death, stroke, rehospitalization or complications than surgery. Altogether, these results indicate that TAVRmay be indicated not only for patients with lower surgical risk, but also for younger patients. Thus, TAVR and ViV procedures are advancing, and in the coming years, there will likely be an even stronger change in the treatment of patients with valve diseases, in operating rooms and cath labs. Recent findings in the literature corroborate a shift in the paradigm to the use of bioprostheses, especially with the advent of PBV and advances in ViV implantation for aortic valve prosthesis failure, recognizing them as state-of-the-art therapies. 1. Brasil. Ministério da Saúde [Internet]. DATASUS. Procedimentos hospitalares do SUS - por gestor – Brasil [acesso em 17 jul 2018]. Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih /cnv/qgbr. def. 2. Head SJ, Çelik M, KappeteinAP. Mechanical versus bioprosthetic aortic valve replacement. Eur Heart J. 2017;38(28):2183-91. 3. Molero Junior JC, Raimundo RD, Amaral JAT, Abreu LC, Breda JR. Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life. Int J Cardiovasc Sci. 2020;33(1):36-42. 4. Repack A, Ziganshin BA, Elefteriades JA, Mukherjee SK. Comparison of quality of life perceived by patients with bioprosthetic versus mechanical valves after composite aortic root replacement. Cardiology. 2016;133(1):3-9. 5. Kottmaier M, Hettich I, Deutsch MA, Badiu C, Krane M, Lange R, et al. Quality of life and anxiety in younger patients after biological versus mechanical aortic valve replacement. Thorac Cardiovasc Surg. 2017;65(3):198-205. 6. Zhao DF, Seco M, Wu JJ, Edelman JB, Wilson MK, Vallely MP, et al. Mechanical versus bioprosthetic aortic valve replacement in middle- aged adults: a systematic review and meta-analysis. Ann Thorac Surg. 2016;102(1):315-27. 7. Evora PRB, Arcêncio L, Evora PM, Menardi AC, Chahud F. Bovine pericardial patch augmentation of one insufficient aortic valve cuspwith twenty-three-year positive clinical follow-up independent of the patch degeneration. Braz J Cardiovasc Surg. 2017;32(1):49-52. 8. Chakravarty T, Patel A, Kapadia S, Raschpichler M, Smalling RW, Szeto WY, et al. Anticoagulation after surgical or transcatheter bioprosthetic aortic valve replacement. J Am Coll Cardiol. 2019;74(9):1190-1200. 9. Stachel G, Woitek FJ, Holzey D, Kiefer P, Haussig S, Leontyev S, et al. Treatment of degenerated aortic bioprostheses: a comparison between conventional reoperation and valve-in-valve transfemoral transcatheter aortic valve replacement. Eur Heart J. 2018;39(suppl 1):ehy564.234. 10. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-15. 11. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-705. References Braile & Zotarelli Filho Heart valve and state of the art Int J Cardiovasc Sci. 2020;33(1):34-35 Editorial This is an open-access article distributed under the terms of the Creative Commons Attribution License