Table 2.

Decision Making Algorithm. m-AVR for young patients.

Supported by EACTS/ESC Guidelines from 2021 [6]	Supported by ACC/AHA Guidelines from 2020 [5]
-Class I SAVR for patients with STS-PROM/EuroSCORE II < 4%, who ask for this type of valve, high risk for accelerated SVD or no contraindication for anticoagulation, -Class IIa for patient already anticoagulated for another mechanical valve, for <60 years. or at high risks of reoperation or TAVI (if appropriate) -Class IIb for patient on long-term anticoagulation.	-Class 1 SAVR for symptomatic, well-informed patients who ask for this type of valve, no contraindication for anticoagulation, >20 years of life expectancy, -Class 1 SAVR for asymptomatic patients, <50% LVEF, >20 years life expectancy or rapid progression\urgency (abnormal exercise test, elevated BNP) -Class 2a for patients younger than < 50 years
Pros	Cons
-Good level of evidence -Long-term functionality -Easy to train -Improved hemodynamics and thrombogenicity -Theoretically, no need of reoperation -Alternatives accesses to total sternotomies, available -Aortic root enlargement possible -Patient already on anticoagulation for life	-Lifelong anticoagulation -Rigorous control of anticoagulation are needed -Restriction in day-by-day activities (recreational or professional) -Psychological disturbances and intellectual level that does not guarantee satisfactory compliance -Noisy for underweighted patients -Hemorrhagically or thrombotic risks dues to age acquired pathologies (loos of memory, tumoral pathologies, increased risks for socially neglected patients) -Not recommended for women contemplating pregnancy