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EDITORIAL

Selection of Valve Substitutes in Young Adults in Asia: An Evolving Issue

Daniel Loisance, MD

Créteil, France

Daniel Loisance, MD Email: Daniel.loisance@wanadoo.fr

The first 300 words of the full text of this article appear below.

Selection of the optimal valve substitute is one of the most difficult issues in the young adult. The recent recommendations of the American Heart Association have solved the problem in patients above 65 years of age: tissue valves are preferable. However, the guidelines are not very precise for patients aged less than 65 years. They point out the recent extension of longevity of the tissue valve and recommend discussing lifestyle issues and risks of anticoagulation and reoperation with the patient. In real life, this recommendation leaves the surgeon with a very difficult predicament, especially in adults aged from 20 to 50 years.

The alternatives are many when valve replacement becomes necessary in the young adult population, i.e., when valve repair appears not to be indicated or has failed. The choice is between a mechanical valve and a tissue valve. Among tissue valves, there is the natural tissue valve: the autograft (Ross operation); the homograft; and the bioprosthesis, porcine or bovine, stented or stentless. All large longitudinal follow-up studies comparing mechanical valves with tissue valves have yielded interesting data at odds with the general perception: patient longevity and rate of reoperation do not differ between tissue and mechanical valves. The only differences are the nature of the valve-related events and the causes of reoperation; mechanical valves are more likely to give hemorrhagic complications, while tissue valves fail because of structural dysfunction and more frequently need repeat replacement. The limitations of these large studies are nevertheless obvious: they did not consider the different age groups in the young adult population; and they involved only the first generation of tissue valves, which obviously are not used anymore. This therefore leaves the cardiologist and the surgeon with a problem. This editorial is intended to help in this difficult decision-making process.

THE PATIENT

Valve selection depends on . . . [Full Text of this Article]

Asian Cardiovasc Thorac Ann 2010; 18:10-12
© 2010 by SAGE Publications
DOI: 10.1177/0218492309355724




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