Tissue valve has a tendency to degenerate early but can be dilated or a valve in valve replacement may be tried by intervention, mechanical valves are durable but needs lifelong anticoagulant therapy with its inherent complications. So, a controversy remains in making a choice.
Though controversy is there, in my opinion, tissue valve is better . Because tissue valve may be replaced later with mechanical valve. But once mechanical valve is disturbed life expectancy would be lessened.
Generally in the pediatric population a biologic valve is often preferred secondary to the the risks of anti-coagulation needed with a mechanical PVR. Some use PTFE bicuspid pulmonary valves that require only low dose ASA without any additional anti-coagulation.
as all low pressure circulation valves, the bioprothetic is more desirable, thelike expectancy of tissue valve in the right side is longer and should the valve developed stenosis later on a transcatheter management is feasible and much easier
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