Introduction In middle-aged adults, the decision to surgically implant a mechanical or a bioprosthetic valve balances the risk of bleeding, mainly associated with mechanical valves and requirement for long-term anticoagulation, with the risk of reoperation secondary to structural valve deterioration as reported with bioprosthetic valves.1 Because of the associated risk of thromboembolic events and stroke, the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines...
