Chordal preservation is important in maintaining LV function after surgery. Severe calcification and subvalvar fibrosis make chordal preservation during surgery difficult.
Coronary angiography prior to surgery for valvular heart disease is considered for those 40 years and above (35 years when there are coronary risk factors).
Candidates for tissue valve (bioprosthetic) replacement: elderly, females planning pregnancy, following infective endocarditis and right sided valve disease
An effective orifice area less than 0.7 square centimeter per square meter of body surface area for aortic valve is taken as patient - prosthesis mismatch.