Patient-Tailored Aortic Valve Replacement.

Ole De Backer,Lars Søndergaard,Christian Lildal Carranza,Ivan Wong,Ben Wilkins

doi:10.3389/fcvm.2021.658016

Abstract

Contemporary surgical and transcatheter aortic valve interventions offer effective therapy for a broad range of patients with severe symptomatic aortic valve disease. Both approaches have seen significant advances in recent years. Guidelines have previously emphasized ‘surgical risk’ in the decision between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), although this delineation becomes increasingly obsolete with more evidence on the effectiveness of TAVR in low surgical risk candidates. More importantly, decisions in tailoring aortic valve interventions should be patient-centered, accounting not only for operative risk, but also anatomy, lifetime management and specific co-morbidities. Aspects to be considered in a patient-tailored aortic valve intervention are discussed in this article.

Highlights

Aortic valve disease—both aortic stenosis (AS) and aortic regurgitation (AR)—represents an important global health problem
Utilizing favorable aspects of the transcatheter heart valve (THV) and/or delivery system to minimize procedural risks and optimize outcomes is strongly recommended
Significant iliofemoral disease is common in transcatheter aortic valve replacement (TAVR) candidates, making the delivery system insertion profile and flexibility highly relevant or even driving the selection of an alternative vascular access

Summary

INTRODUCTION

Aortic valve disease—both aortic stenosis (AS) and aortic regurgitation (AR)—represents an important global health problem. This access offers an excellent overview and the possibility of performing all types of surgical aortic valve intervention and even a combination of different open-heart procedures. If deep sternal infection occurs, the mortality is significant with mortality rates of 1–19% [15] Another access to the aortic valve can be through minimal invasive surgical incisions, which has been developed since the 90’s. Minimal invasive aortic valve surgery (MIAVS) access is normally either in the form of an upper hemi-sternotomy (UHS) or through a right anterior thoracotomy (RAT). Both techniques have great success if the surgical team is experienced with these minimally invasive techniques. The benefits of MIAVS are cosmetic, less pain, less bleeding, shorter duration of mechanical ventilation, shorter ICU and hospital stay as well as a faster recovery [16]

TYPES OF SURGICAL INTERVENTION

Aortic Root Replacement

SUMMARY

AORTIC VALVE AND AORTIC ROOT

PATIENT CHARACTERISTICS

CONCLUSIONS