Table 3.

Decision Making Algorithm. Bio-SAVR for young patients.

Supported by EACTS/ESC Guidelines from 2021 [6]	Supported by ACC/AHA Guidelines from 2020 [5]
-Class I SAVR for: patient desire, risks for anticoagulation, life expectancy lower than the presumed durability of the prothesis, previous mechanical valve thrombosis or STS-PROM/EuroSCORE II < 4% -Class IIa for low likelihood or low risks for future redo or women contemplating pregnancy. -Class IIb for patients on long-term NOAC for high risk of thromboembolism	-Class 1 SAVR for symptomatic or asymptomatic well-informed patients of any age who ask for this type of valve, with contraindication for anticoagulation, with or without depressed LVEF (<50%), >20 years of life expectancy, rapid progression or urgency (abnormal exercise test, elevated BNP) -Class 2b percutaneous balloon dilatation as bridge to SAVR or TAVI for critically ill patient
Pros	Cons
-Good level of evidence; good long-term data -Promising new available technologies incorporated into the recent generations -Easy to use; early mentored by the residency programs -Multiple’s approaches/access available -Good choice in case of complex or urgent surgeries -Good choice for women contemplating pregnancy	-SVD in this category of age with increased risk of reoperation
-Quality of life over the mechanical valves -An option for anticoagulation contraindication -Annular enlargement possible -Valve-in-Valve may be possible in large prothesis. -Good choice for patients with different types of handicaps