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Front. Surg. | doi: 10.3389/fsurg.2018.00018

Surgery for young adults with aortic valve disease not amenable to repair

 Mustafa Zakkar1*, Vito D. Bruno1,  Alexandru C. Visan1, Stephanie Curtis1,  Gianni Angelini1, EMMANUEL LANSAC2 and SERBAN STOICA1
  • 1Cardiac Surgery, University of Bristol, United Kingdom
  • 2Institute Mutualiste Montsouris, France

Aortic valve replacement is the gold standard for the management of patients with severe aortic stenosis or mixed pathology that is not amenable to repair according to currently available guidelines. Such a simplified approach may be suitable for many patients, but it is far from ideal for young adults considering emerging evidence demonstrating that conventional valve replacement in this cohort of patients is associated with inferior long-term survival when compared to the general population. Moreover; the utilisation of mechanical and bioprosthetic valves can significantly impact on quality and is linked to increased rates of morbidities. Other available options such as stentless valve, homografts, valve reconstruction and Ross operation can be an appealing alternative to conventional valve replacement.
Young patients should be fully informed about all the options available - shared decision making is now part of modern informed consent. This can be achieved when referring physicians have a better understanding of the short and long term outcomes associated with every intervention, in terms of survival and quality of life.
This review presents up to date evidence for available surgical options for young adults with aortic stenosis and mixed disease not amenable to repair.

Keywords: aortic valve replacement, Ross operation, Homograft, Young Adult, aortic stenosis

Received: 12 Dec 2017; Accepted: 12 Feb 2018.

Edited by:

Patrick O. Myers, Université de Genève, Switzerland

Reviewed by:

Vladimiro Vida, Università degli Studi di Padova, Italy
Victor Bautista-Hernandez, Servicio Gallego de Salud, Spain
Martin Schweiger, University Children's Hospital Zurich, Switzerland  

Copyright: © 2018 Zakkar, Bruno, Visan, Curtis, Angelini, LANSAC and STOICA. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mr. Mustafa Zakkar, University of Bristol, Cardiac Surgery, Bristol, United Kingdom, mz14842@bristol.ac.uk