Options for Aortic Valve Replacement Vary in Younger Patients

Aortic valve replacement is one of the most common open heart procedures performed by cardiothoracic surgeons. Although the choice of approach is fairly standard for patients older than 70 years, the best approach for younger patients is less clear.

Adult Cardiac: Aortic Valve/Novel Technologies

Tuesday, January 30
3:30 p.m. – 5:30 p.m.
Floridian Ballroom D

American and European guidelines on valvular heart disease recommend mechanical prostheses for patients younger than 60 years, but the use of bioprosthetic valves has substantially increased, and some studies have shown that mid- to long-term survival rates are similar for both types of valves.

Ibrahim Sultan, MD

A three-way debate during this afternoon’s Adult Cardiac: Aortic Valve/Novel Technologies session will shed light on this issue. Three cardiothoracic surgeons will discuss the case of a 50-year-old patient with severe symptomatic aortic insufficiency and a non-aneurysmal bicuspid aortic valve, with each surgeon presenting a different approach: isolated valve repair, mechanical aortic valve replacement, and bioprosthetic aortic valve replacement.

“Prosthetic valve choice is important to our patients because the kind of valve chosen acts as a surrogate for life expectancy and need for reoperative heart surgery,” said Ibrahim Sultan, MD, of the University of Pittsburgh, a moderator of the session and a speaker in the debate.

Decision making is complex because of the risk/benefit ratios for each approach. “Aortic valve repair is an excellent choice in young patients with aortic insufficiency and sinus of Valsalva (SOV) aneurysms,” said Dr. Sultan. “However, in the absence of SOV aneurysm, isolated aortic valve repair may not be as durable. Patients may require reoperation at 10 years or less.”

With regard to valve replacement, mechanical aortic valve replacements may outlast a patient’s life, but require anticoagulation and are associated with bleeding risks. In contrast, bioprosthetic aortic valves do not require therapeutic anticoagulation, but carry greater risk for structural valve deterioration, with reoperation or transcatheter aortic valve replacement being needed at an average of 13 years.

Dr. Sultan encouraged attendees to come with questions and help stimulate discussion about each of the viewpoints.

“We want attendees to go home with a better understanding of the most appropriate option based on the specific advantages and disadvantages of each approach, the clinical characteristics of the patient, and the patient’s preferences,” he added.