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08:50
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
11.8K
Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years.
Serban Stoica1, Chloe Beard2, Johanna J M Takkenberg3
1Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK serban.stoica@uhbw.nhs.uk.
Heart (British Cardiac Society)
|February 27, 2023
Summary
Expert consensus clarifies surgical options for aortic valve replacement (AVR) in adults aged 18-60. The Ross procedure shows high suitability, alongside conventional mechanical AVR and tissue AVR, for specific patient profiles.
Area of Science:
- Cardiovascular Surgery
- Adult Cardiac Surgery
- Aortic Valve Disease
Background:
- Uncertainty exists regarding optimal surgical procedures for aortic valve replacement (AVR) in adults aged 18-60.
- Available options include conventional AVR (mechanical and tissue valves), the pulmonary autograft (Ross procedure), and aortic valve neocuspidisation (Ozaki procedure).
- Transcatheter aortic valve implantation is considered for select patients.
Purpose of the Study:
- To establish consensus-based recommendations on the suitability of different AVR procedures for adult patients aged 18-60.
- To address uncertainty surrounding the choice of surgical intervention for aortic valve disease in this demographic.
Main Methods:
- Formal consensus methodology was employed, involving a working group and a patient advisory group.
- A consensus group of 12 clinicians rated the appropriateness of each procedure for various clinical scenarios using a 9-point Likert scale.
- Two rating rounds were conducted before and after a dedicated consensus meeting.
Main Results:
- Consensus was reached on the appropriateness of procedures across diverse clinical scenarios.
- Mechanical AVR (mAVR) was deemed appropriate in 57% and inappropriate in 19% of scenarios.
- Tissue AVR (tAVR) was appropriate in 68% of scenarios, with no inappropriate ratings.
- The Ross procedure was appropriate in 39% and inappropriate in 27% of scenarios.
- Aortic valve neocuspidisation (Ozaki) had low appropriateness ratings (3% A, 28% I).
- Transcatheter aortic valve implantation was appropriate in only 7% of scenarios, primarily for frail patients or those with limited life expectancy.
Conclusions:
- Expert opinion indicates high certainty regarding the suitability of the Ross procedure for patients aged 18-60, beyond conventional AVR options.
- Future clinical guidelines should incorporate the Ross procedure as a viable option in aortic prosthetic valve selection.
- The consensus process provides evidence-based guidance for AVR decision-making in adult patients.
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