Living with a prosthetic heart valve:
follow-up, medications and daily life

Article written and reviewed by Dr Luca Moretti

After valve replacement, many people can return to an active life, but the prosthesis requires lifelong follow-up. The main considerations concern valve function, antithrombotic medications, prevention of endocarditis and the development of any new symptoms.
The rules differ partly between mechanical prostheses, surgical bioprostheses and transcatheter valves.

Having a prosthetic valve does not mean that every symptom is caused by the valve. It does mean, however, that unexplained fever, new shortness of breath, a clear reduction in exercise capacity or other important changes should be reported without waiting for the scheduled follow-up.

Which follow-up tests are needed after the procedure

The first reference point is cardiology follow-up with an echocardiogram. After implantation, the function of the prosthesis is recorded while it is still new: gradients, any regurgitation, ventricular function and other parameters become the baseline for comparison with later examinations.
The 2025 ESC/EACTS guidelines recommend lifelong clinical and echocardiographic follow-up. For bioprostheses, an echocardiogram is planned within about three months after implantation, at one year and then every year, or earlier if symptoms develop.

If transthoracic echocardiography does not clarify a suspected problem, transesophageal echocardiography, computed tomography or, for some mechanical prostheses, fluoroscopy may be used. These tests are not all routine follow-up examinations: they are selected when there is a specific clinical question.

Medications and anticoagulation: what changes between mechanical and biological prostheses

Anyone with a mechanical prosthesis must take a vitamin K antagonist for life and keep the INR within the target range established by the treating center. The correct value depends on the type and position of the prosthesis and the individual risk of thrombosis.
Missing doses, changing the medication independently or replacing it with a direct oral anticoagulant can expose the patient to prosthetic valve thrombosis and embolism.

With a biological prosthesis, antithrombotic therapy depends on the valve position, type of implantation and time since the procedure. There may also be another indication for anticoagulation, such as atrial fibrillation or venous thromboembolism.
For this reason, the prescribed medication cannot be inferred simply from the fact that the valve is “biological.”

Before surgery, endoscopy or dental procedures, the presence of the prosthesis and any anticoagulant treatment should always be declared. In people with mechanical valves, the 2025 ESC/EACTS guidelines state that several minor procedures, including dental cleaning, treatment of dental caries and some extractions, can be performed without interrupting the VKA; for procedures with higher risk, the strategy must be planned individually.

Dentist, oral hygiene and prevention of endocarditis

People with a prosthetic heart valve, whether surgical or transcatheter, are considered at high risk of infective endocarditis. Prevention does not consist only of taking an antibiotic before certain procedures: maintaining good oral hygiene, promptly treating dental and skin infections and informing dentists and physicians about the prosthesis are important.

ESC guidelines recommend antibiotic prophylaxis in people with prosthetic valves when at-risk dental procedures are performed, such as extractions, oral surgery and procedures that manipulate the gingiva or the periapical region of the teeth.
Prophylaxis should not, however, be taken without medical guidance and is not prescribed in the same way for every visit or procedure.

A fever without a clear cause, especially if persistent or associated with chills, unusual fatigue or worsening cardiac status, should be reported to a physician. Taking antibiotics independently before assessment can make it more difficult to identify a possible infection.

Physical activity, work, travel and diet

After recovery from the procedure, physical activity is generally useful and can be included in a cardiac rehabilitation program. The 2026 ESC cardiac rehabilitation guidelines recommend considering structured exercise after valve surgery or transcatheter treatment to improve functional capacity.
The permitted level of activity still depends on cardiac function, any other valve diseases, arrhythmias, coronary artery disease and the response to exercise.

People taking anticoagulants should pay particular attention to sports with a high risk of collision or trauma. Otherwise, travel, work and social life are often compatible with a prosthetic valve, provided continuity of treatment and follow-up is ensured.
During prolonged travel, it is useful to carry a medication list and prosthesis information and, if a VKA is used, arrange INR monitoring in advance when necessary.

With vitamin K antagonists, foods containing vitamin K do not need to be eliminated completely. It is more important to avoid large sudden changes in intake and to follow the anticoagulation center’s instructions because diet, other medications and acute illnesses can alter the INR.

When to contact the physician before the scheduled follow-up

New shortness of breath, reduced ability to walk or exert yourself, leg swelling, persistent palpitations, syncope, unexplained fever or neurological symptoms warrant assessment. In someone with a prosthesis, these symptoms can have many causes, but possibilities also include prosthetic valve dysfunction, thrombosis or endocarditis.

In bioprostheses, function can change progressively because of structural valve deterioration. In mechanical prostheses, one of the most important complications is prosthetic valve thrombosis.
A problem recognized early can often be investigated and treated before it causes major deterioration in the clinical condition.

Frequently asked questions about living with a prosthetic heart valve

Can you lead a normal life?
Often, yes, after recovery and in the absence of other cardiac limitations. Follow-up and certain specific precautions remain necessary.

How often should the prosthesis be checked?
The schedule is individualized. Follow-up is nevertheless lifelong; for bioprostheses, guidelines call for regular echocardiographic examinations, annually after the first year.

Can I stop the anticoagulant for dental treatment?
Not without medical guidance. Many minor dental procedures can be performed without stopping the VKA, but the decision must be agreed in advance.

Is antibiotic prophylaxis needed for dental treatment?
Yes, for at-risk dental procedures in people with prosthetic heart valves, according to the regimen prescribed by the physician or dentist.

Can you exercise?
Often, yes, at an intensity appropriate to cardiac function and the clinical situation. With anticoagulants, the risks associated with trauma must also be considered.