Current surgical bioprostheses: Looking to the future

The utilization of bioprostheses for surgical heart valve replacement has been increasing across all age groups. For patients, the appeal of the bioprosthetic valve rests with the avoidance of anticoagulation, fewer thrombotic and hemorrhagic events, and the increasing availability of transcatheter valve-in-valve interventions -both in the aortic and mitral positions- allowing for lower morbidity reinterventions. While improvements in valve hemodynamics and long-term durability have made bioprostheses a reasonable choice for a growing number of patients, challenges do remain. With increasing usage of bioprostheses, especially in younger patients, there will be an increase in the projected number of failing bioprosthetic valves. This trend will bring even more emphasis to maximizing long-term durability, optimizing anticoagulation, and promoting patient-level decision making around prosthesis choice.