Aortic valve replacement in non-elderly: the gap between reality, guidelines and evidence

Abstract

OBJECTIVE There are several treatment options for non-elderly adults (18–60 years) in need of aortic valve replacement (AVR): a mechanical or biological substitute, a homograft, the Ross procedure, or nowadays even transcatheter aortic valve replacement (TAVR). This study evaluated the current opinions and practices of cardiac surgeons and cardiologists concerning aortic valve replacement strategies in this patient group. METHODS A 43-item online survey was sent out to several scientific organisations, individual cardiac surgeons, cardiologists, and residents/fellows worldwide. RESULTS Two-hundred-twenty-two physicians from 33 different countries answered the survey. The UK (24%), Belgium (23%), and North America (22%) are best represented. A mechanical valve is the most frequently used substitute in non-elderly. With increasing patient age, the popularity of a biological valve increases. TAVR and the Ross procedure are each used in less than 10% of this cohort. Only 12% of the cardiac surgeons has experience with the Ross surgery. In 23% the patient seems not to be involved in the decision on the type of valve substitute. CONCLUSION The preferred surgical treatment for non-elderly patients in need for aortic valve replacement differs widely. To enable a shared decision-making process including patient preferences, there is more need for collaboration between cardiac departments, as well as education and scientific research about patient centred outcomes of the different AVR techniques.