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Updated: Jul 15, 2025
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Aortic valve replacement in non-elderly: the gap between reality, guidelines and evidence
Lise Geuens1, Lucas Van Hoof1, Alexander Van De Bruaene2
1Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
Summary
Treatment choices for aortic valve replacement (AVR) in non-elderly adults vary significantly. Mechanical valves are common, but patient involvement in decisions about AVR strategies needs improvement for shared decision-making.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Aortic valve replacement (AVR) in non-elderly adults (18-60 years) presents diverse therapeutic options including mechanical valves, biological valves, homografts, the Ross procedure, and transcatheter aortic valve replacement (TAVR).
- Understanding current clinical practices and physician perspectives on AVR strategies for this demographic is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the contemporary opinions and practices of cardiac surgeons and cardiologists regarding aortic valve replacement (AVR) strategies in non-elderly adult patients.
- To identify trends and variations in the selection of prosthetic valves and surgical approaches for AVR in this specific patient cohort.
Main Methods:
- An online survey comprising 43 items was distributed globally to cardiac surgeons, cardiologists, and trainees.
- Responses were collected from 222 physicians across 33 countries, with significant representation from the UK, Belgium, and North America.
Main Results:
- Mechanical valves are the most frequently utilized substitutes for AVR in non-elderly patients, with biological valve popularity increasing with patient age.
- The Ross procedure and transcatheter aortic valve replacement (TAVR) are each employed in less than 10% of cases, and only 12% of surgeons have experience with the Ross procedure.
- A notable finding was that in 23% of cases, patients were not involved in the decision-making process regarding the type of valve substitute.
Conclusions:
- Significant variability exists in the preferred surgical treatments for AVR among non-elderly patients.
- Enhanced collaboration among cardiac departments, alongside focused education and research on patient-centered outcomes of different AVR techniques, is essential.
- Promoting shared decision-making requires greater integration of patient preferences into the AVR strategy selection process.
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