DISCUSION
Symptomatic severe aortic stenosis is associated with high mortality rates, ~ 50% at 1 year, and the prevalence will likely increase as the population ages. In this pathology, interventional procedures (surgery is still the gold standard, especially in younger patients) have been shown to drastically reduce mortality and improve quality of life. 15,16 Nevertheless, in many cases when we replace the diseased AV with a prosthesis we are changing one problem for another. Many complications have been described in heart valve prosthesis, but of particular interest to us are the complications derived from poor OAC therapy control (mechanical prosthesis) and those due to the rapid degeneration of biological prosthesis.2-4,17 Most of the patients in the Peruvian public health system are poor and do not have timely access to health services, which is why it is difficult to provide adequate OAC therapy in these patients, many of whom are from the interior of the country and they come to the capital just for the surgery. Early degeneration of biological prosthesis generates more public spending (mainly because trans-catheter therapy is now preferred) and a higher risk of mortality due to reoperation. AVRec surgery offers many advantages, mainly avoid OAC therapy and promises to be a technique with excellent long-term results, so it is a relatively economical technique compared to AV replacement, we believe it is an ideal choice for developing countries. This idea is supported by other authors.18,19