Should we offer a bioprosthetic valve to women of child-bearing age who need valve replacement?

Pregnancy is associated with hypercoagulability and hemodynamic instability. Mechanical valves pose a special problem during pregnancy. Warfarin, the most effective drug for preventing valve complications, is teratogenic and also increases fetal loss. Other anticoagulant regimens are less effective and therefore increase the risk of maternal and fetal complications. Chronic anticoagulation can also significantly affect young patient's quality of life. Biological valves do not require maintenance of any kind and do not pose special risk during pregnancy. However, they degenerate with time, requiring reintervention. Practice guidelines are gradually moving toward recommending biological valves in the majority of young women. There are emerging solutions for valve degeneration that will further tilt the balance in favor of these valves.