Which Valve to Who: Prosthetic Valve Selection for Aortic Valve Surgery

Harken et al. had performed the first aortic valve replacement in subcoronary position in 1960 (Harken, 1960). The “caged ball” valve used in this operation pioneered to the prosthetic valves and in the last 50 years many valve types were begun to be used. The early and long term results of the patients undergone aortic valve surgery do not depend not only the patient-related factors and the type of the surgery. The selected prosthetic valve is one of the most important factor affecting survival. According to the analysis of the multicenter randomized trials made by Hammermeister et al. involving the recent 15 years, more than one third of the deaths among the patients undergone aortic valve surgery were found to be related to the prosthetic valve (Hammermeister, 2000). The expectance from an ideal prosthetic valve is to correct the present valve pathology, to possess normal functions, to normalize patient’s life standards or at least to improve it obviously, and to preserve this status during the patient’s lifelong. Additionally, the implantation of the ideal prosthetic valve should be easy, the prosthetic valve should be replaced with low mortality and morbidity, should not cause a damage to the cardiovascular system, the hospitalization period should be short, the valve should be inexpensive (Rahimtoola, 2010). In spite of the whole developments in the prosthetic valve technology, the ideal prosthetic valve is not found yet, that’s why the task of the surgeon is to select the prosthetic valve not depending on the nature of the disease but should be individualized to each patient. Nowadays, the replacement alternatives for aortic valve replacement are mechanical valves, biological xenograft valves, homograft valves, autograft valves and valves implanted transapically or percutaneously which usage has increased in the recent years. Because of various advantages and disadvantages, these alternatives are prefered to each other. However, for the most appropriate valve choice, each patient should be evaluated individually. Additionally, improvements in the drug technology and risk preventing measures, due to the deceleration in the development of cardiovascular diseases, the age of the operated patients and the surviving period following the operation is increasing gradually. Cardiovascular diseases become the most important factor determining the life quality and surviving ratio in the elderly population. The main purpose of the aortic valve replacement is the improvement of life quality by prolonging the patient’s life (Kolh, 2007;