Aortic Valve Replacement in Children and Young Adults.

SEE PAGE 2858 T he perfect heart valve substitute has not yet been developed and matching the patient to existing options to optimize survival and reduce valve-related complications remains challenging. The choices for aortic valve replacement (AVR) are mechanical valves, bioprosthetic valves, and biological valves such as aortic valve homograft and the Ross procedure (pulmonary autograft). The latter is a complex operation because it transfers the patient’s own pulmonary valve into the aortic position and uses a biological valve to replace the pulmonary valve, transforming a single-valve disease into a 2-valve disease. These considerations are not important to most North American patients who undergo AVR because they are older and the durability of bioprosthetic valves in this age group is excellent (1,2). The risk of bioprosthetic valve failure 20 years after AVR is <10% in patients 70 years of age and older (1,2). A report based on the Society of Thoracic Surgeons Database from January 1997 to December 2006 showed that 108,687 patients had isolated AVR and the mean age was 69 years (3). The use of bioprosthetic heart valves increased from 43.6% in 1997 to 78.4% in 2006 (3). This shift from mechanical to bioprosthetic valves preceded the introduction of transcatheter aortic valve implantation into clinical practice and there is no rational reason for this because the results of numerous retrospective studies and 3 randomized clinical trials have failed to conclusively show survival benefit of one over the other