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Abstract This is because there is no ideal substitute that offers long-term durability, without the need for oral anticoagulants, no increased risk of thromboembolism and a functional mechanism similar to the native mitral valve. This decision becomes an even greater challenge when patients have coexisting conditions, such as advanced age, congestive heart failure, coronary artery disease, lung disease or renal failure. The increase in life expectancy and in comorbidities among patients needing valve replacement means that choosing the most effective treatment (valvuloplasty, mechanical prosthesis or bioprosthesis) demands consideration of additional factors. The process of deciding which prosthetic valve type is best for an individual patient is complex. Consideration of the general advantages and disadvantages of the valve types, as outlined above, is only the first step. These general recommendations need to be then tailored to the individual patient’s clinical condition and, equally importantly, personal preferences. Once the specific advantages and disadvantages are considered in the context of the individual patient, then the information needs to be communicated in an effective way for the provider and patient to fully comprehend the consequences of valve selection. Finally, frameworks to allow for incorporation of the myriad factors to aid decision-making are necessary. |