Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old

Abstract

Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross proceduresurvival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.

Physical and Mental Recovery after Aortic Valve Surgery in Non-Elderly Patients: Native Valve-Preserving Surgery vs. Prosthetic Valve Replacement

“…In our patients, native valve preservation was associated with increased risk of treatment failure, more specifically, AV reoperation for failed AV repair, in NV patients, which is in line with previous findings [11,29,30]. A learning curve with a more liberal/aggressive approach to AV repair at the beginning of the study (i.e., performing AV repair in unicuspid morphology using the bicuspidization procedure [31], in bicuspid morphology with large calcifications and a severely restrictive raphe, and in bicuspid/tricuspid morphology with large fenestrations necessitating patch augmentation) might have contributed to this.…”

“…In recent decades, both procedures have become an integral part of the surgical treatment protocols in non-elderly adults presenting with severe AV disease, especially when performed at dedicated centers [8]. Both AV repair and the Ross procedure offer the potential benefit of reduced risk of valve-related complications compared with prosthetic AVR, but at the potential expense of increased risk of valve-related reoperation [6,7,[9][10][11]. Moreover, both procedures potentially allow postoperative hemodynamics similar to those of well-functioning, native valves to be achieved due to the absence of a rigid sewing ring and the preservation of native aortic root geometry, permitting transvalvular flow characteristics and left ventricular dynamics to be preserved [12].…”

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

“…The median number of cardiac surgeons per centre is 6.0 . In Belgium this is 3.0 [2][3][4][5][6][7][8][9][10], in the USA 5.5 [1][2][3][4][5][6][7][8][9][10][11][12][13][14], in Canada 6.0 [4][5][6][7][8][9][10][11][12], in the UK this is 7.0 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], and in Germany 12.0 .…”

“…Sixty-two percent of the participants in our survey believed a mechanical substitute offers a lifelong solution. Nevertheless, the annual reoperation rate of mechanical AVR is about 0.5% and is mostly associated with urgent indications such as prosthesis failure, endocarditis and thrombosis [ 7 ]. Due to the need of oral anticoagulation therapy mechanical aortic valves are associated with a higher risk for thromboembolic and bleeding events, about 1.7% annually [Error!…”

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

“…Valve repair can avoid the burden of lifelong anticoagulant treatment for patients but increases the risk of reoperation ( 8 ). Different postoperative management strategies are associated with different risk levels and complications, differentially affecting the quality of life of patients ( 9 ). Therefore, there is a need to develop appropriate customized strategies for each patient undergoing valve replacement to ensure safety and improve clinical outcomes.…”