Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.

Lansac, E., Youssefi, P., de Heer, F., Bavaria, J., De Kerchove, L., El-Hamamsy, I., et al. (2019). Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR. SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 31(4), 643-649 [10.1053/j.semtcvs.2019.05.033].

Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR

De Paulis R.;
2019-01-01

Abstract

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.
2019
Pubblicato
Rilevanza internazionale
Recensione
Sì, ma tipo non specificato
Settore MED/23 - CHIRURGIA CARDIACA
English
;
AVIATOR; Aortic valve surgery; Nonelderly patients; Adult; Age Factors; Aortic Valve; Bioprosthesis; Evidence-Based Medicine; Heart Valve Diseases; Heart Valve Prosthesis; Life Expectancy; Middle Aged; Prosthesis Failure; Recovery of Function; Registries; Risk Factors; Time Factors; Treatment Outcome; Heart Valve Prosthesis Implantation; Transcatheter Aortic Valve Replacement
Lansac, E., Youssefi, P., de Heer, F., Bavaria, J., De Kerchove, L., El-Hamamsy, I., et al. (2019). Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR. SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 31(4), 643-649 [10.1053/j.semtcvs.2019.05.033].
Lansac, E; Youssefi, P; de Heer, F; Bavaria, J; De Kerchove, L; El-Hamamsy, I; Elkhoury, G; Enriquez-Sarano, M; Jondeau, Ldg; Kluin, J; Pibarot, P; Schafers, H-; Vanoverschelde, J-; Takkenberg, Jjm; Dinges, C; Steindl, J; Ziller, R; Benkacem, T; Coulon, C; Kaddouri, F; de Meester, C; Pasquet, A; Nijs, J; Van Mossevelde, V; Loeys, B; Meuris, B; Schepmans, E; Van den Bossche, K; Verbrugghe, P; Goossens, W; Gutermann, H; Pettinari, M; Lenoir, M; Noly, P-; Tousch, M; Shah, P; Boodhwani, M; Rudez, I; Baric, D; Unic, D; Varvodic, J; Gjorgijevska, S; Vojacek, J; Zacek, P; Karalko, M; Hlubocky, J; Novotny, R; Slautin, A; Soliman, S; Arnaud-Crozat, E; Boignard, A; Fayad, G; Bouchot, O; Albat, B; Leguerrier, A; Doguet, F; Fuzellier, J-; Glock, Y; Fernandez, G; Chatel, D; Zeitoun, Dm; Jouan, J; Di Centa, I; Obadia, J-; Leprince, P; Houel, R; Bergoend, E; Lopez, S; Berrebi, A; Tubach, F; Monin, J-; Pousset, S; Mankoubi, L; Noghin, M; Diakov, C; Czytrom, D; Borger, M; Aicher, D; Rauch, S; Theisohn, F; Ferrero, P; Stoica, S; Matuszewski, M; Yiu, P; Bashir, M; Ceresa, F; Patane, F; De Paulis, R; Chirichilli, I; Masat, M; Antona, C; Contino, M; Mangini, A; Romagnoni, C; Grigioni, F; Rosa, R; Okita, Y; Miyairi, T; Kunihara, T; Koolbergen, D; Bekkers, J; Klautz, R; Van Brakel, T; Arabkhani, B; Mecozzi, G; Accord, R; Jasinski, M; Aminov, V; Svetkin, M; Kolesar, A; Sabol, F; Toporcer, T; Bibiloni, I; Rabago, G; Alvarez-Asiain, V; Melero, A; Sadaba, R; Aramendi, J; Crespo, A; Porras, C; Masip, Ae; Milewski, R; Moeller, P; Wenger, I; Leon, C; Marnette, Jm; Doisy, V; Wautot, F; Bourguignon, T; Cameron, D; Chen, E
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/268237
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