American Board of Internal Medicine (ABIM) Certification Practice Exam

In which circumstance is a bioprosthesis preferred for valve replacement?

1. When patient is over 75 years of age

2. When anticoagulant therapy is contraindicated or not desired

3. When a patient has a history of stroke

4. When performing a minimally invasive procedure

The correct answer is: When anticoagulant therapy is contraindicated or not desired

A bioprosthesis is preferred for valve replacement particularly in circumstances where anticoagulant therapy is contraindicated or not desired. Bioprosthetic valves generally do not require long-term anticoagulation, which is a significant advantage for patients who may have conditions or risk factors that make anticoagulant therapy hazardous or undesirable. For example, older patients, those with a high risk of bleeding, or patients who do not wish to manage the complexities that come with anticoagulation therapy benefit more from bioprosthetic valves because of their lower associated risk of thromboembolic complications compared to mechanical valves. While it's true that older age can play a role in selecting bioprosthetic valves due to their longevity and lower chance of complications, the primary factor remains the need to avoid anticoagulants. Patients with a history of stroke might also be considered for bioprosthetic valves; however, the indication for anticoagulation therapy would be evaluated on an individual basis and isn't a universal reason for preferring a bioprosthesis. Lastly, while minimally invasive procedures are advancing, the choice of valve type does not inherently depend on the approach but rather on the specific needs of the patient, including their desire or need for anticoagulation management.