Over 70 years after the first successful implantation of an artificial heart valve, cardiovascular medicine now offers a broad spectrum of treatment options for heart valve diseases [1, 2]. The goal is to develop patient-specific treatment plans through an interdisciplinary heart team, following the principle of lifetime management of heart valve disease. This approach often necessitates intensive discussions between the treating disciplines and the patients themselves [1]. Although mechanical heart valve prostheses fulfil this principle of a lifelong solution in the ideal case with only a single operation, they nowadays play a more subordinate role in western countries compared to biological prostheses and interventional procedures. Ultimately, the trade-off between mechanical and biological prostheses typically hinges on a patient-specific assessment of the risk of coagulation-related complications associated with mechanical prostheses versus the risk of redo surgery due to the limited durability of biological prostheses. In this context this article discusses 1) lifelong anticoagulation and coagulation-associated complications, 2) durability and hemodynamic aspects, 3) outcomes following mechanical and biological valve replacement and 4) patient-specific considerations and lifetime management based on current guidelines and the literature.
