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      Bioprosthetic Aortic Valve Replacement in <50 Years Old Patients – Where is the Evidence?

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          Abstract

          Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases.

          There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.

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          Most cited references64

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          A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.

          Bernard Iung, Gabriel Baron, Eric G Butchart … (2003)
          To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines. The Euro Heart Survey on VHD was conducted from April to July 2001 in 92 centres from 25 countries; it included prospectively 5001 adults with moderate to severe native VHD, infective endocarditis, or previous valve intervention. VHD was native in 71.9% of patients and 28.1% had had a previous intervention. Mean age was 64+/-14 years. Degenerative aetiologies were the most frequent in aortic VHD and mitral regurgitation while most cases of mitral stenosis were of rheumatic origin. Coronary angiography was used in 85.2% of patients before intervention. Of the 1269 patients who underwent intervention, prosthetic replacement was performed in 99.0% of aortic VHD, percutaneous dilatation in 33.9% of mitral stenosis, and valve repair in 46.5% of mitral regurgitation; 31.7% of patients had > or =1 associated procedure. Of patients with severe, symptomatic, single VHD, 31.8% did not undergo intervention, most frequently because of comorbidities. In asymptomatic patients, accordance with guidelines ranged between 66.0 and 78.5%. Operative mortality was <5% for single VHD. This survey provides unique contemporary data on characteristics and management of patients with VHD. Adherence to guidelines is globally satisfying as regards investigations and interventions.
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            Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.

            Alain Cribier, Hélène Eltchaninoff, Assaf Bash … (2002)
            The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was developed. After ex vivo testing and animal implantation studies, the first human implantation was performed in a 57-year-old man with calcific aortic stenosis, cardiogenic shock, subacute leg ischemia, and other associated noncardiac diseases. Valve replacement had been declined for this patient, and balloon valvuloplasty had been performed with nonsustained results. With the use of an antegrade transseptal approach, the PHV was successfully implanted within the diseased native aortic valve, with accurate and stable PHV positioning, no impairment of the coronary artery blood flow or of the mitral valve function, and a mild paravalvular aortic regurgitation. Immediately and at 48 hours after implantation, valve function was excellent, resulting in marked hemodynamic improvement. Over a follow-up period of 4 months, the valvular function remained satisfactory as assessed by sequential transesophageal echocardiography, and there was no recurrence of heart failure. However, severe noncardiac complications occurred, including a progressive worsening of the leg ischemia, leading to leg amputation with lack of healing, infection, and death 17 weeks after PHV implantation. Nonsurgical implantation of a prosthetic heart valve can be successfully achieved with immediate and midterm hemodynamic and clinical improvement. After further device modifications, additional durability tests, and confirmatory clinical implantations, PHV might become an important therapeutic alternative for the treatment of selected patients with nonsurgical aortic stenosis.
            Article 0 comments Cited 365 times – based on 0 reviews     Review now
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              Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis.

              Anne Rossebø, Terje R Pedersen, Kurt Boman … (2008)
              Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results. We conducted a randomized, double-blind trial involving 1873 patients with mild-to-moderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. The primary outcome was a composite of major cardiovascular events, including death from cardiovascular causes, aortic-valve replacement, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting, percutaneous coronary intervention, and nonhemorrhagic stroke. Secondary outcomes were events related to aortic-valve stenosis and ischemic cardiovascular events. During a median follow-up of 52.2 months, the primary outcome occurred in 333 patients (35.3%) in the simvastatin-ezetimibe group and in 355 patients (38.2%) in the placebo group (hazard ratio in the simvastatin-ezetimibe group, 0.96; 95% confidence interval [CI], 0.83 to 1.12; P=0.59). Aortic-valve replacement was performed in 267 patients (28.3%) in the simvastatin-ezetimibe group and in 278 patients (29.9%) in the placebo group (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P=0.97). Fewer patients had ischemic cardiovascular events in the simvastatin-ezetimibe group (148 patients) than in the placebo group (187 patients) (hazard ratio, 0.78; 95% CI, 0.63 to 0.97; P=0.02), mainly because of the smaller number of patients who underwent coronary-artery bypass grafting. Cancer occurred more frequently in the simvastatin-ezetimibe group (105 vs. 70, P=0.01). Simvastatin and ezetimibe did not reduce the composite outcome of combined aortic-valve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.) 2008 Massachusetts Medical Society
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                Author and article information

                Contributors
                Amer Harky:
                ORCID: http://orcid.org/0000-0001-5507-5841
                Role: MRCSRole: MSc
                Michael Man Yuen Suen: Role: MBChB
                Chris Ho Ming Wong: Role: MBChB
                Abdul Rahman Maaliki: Role: MD
                Mohamad Bashir: Role: MDRole: PhD
                Journal
                Journal ID (nlm-ta): Braz J Cardiovasc Surg
                Journal ID (iso-abbrev): Braz J Cardiovasc Surg
                Journal ID (publisher-id): rbccv
                Title: Brazilian Journal of Cardiovascular Surgery
                Publisher: Sociedade Brasileira de Cirurgia Cardiovascular
                ISSN (Print): 0102-7638
                ISSN (Electronic): 1678-9741
                Publication date (Print and electronic): Nov-Dec 2019
                Publication date (Print): Nov-Dec 2019
                Volume: 34
                Issue: 6
                Pages: 729-738
                Affiliations
                [1 ]Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
                [2 ]Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
                [3 ]Manchester Royal Infirmary, Oxford Road, Manchester, UK.
                Author notes
                Correspondence Address: Amer Harky, https://orcid.org/0000-0001-5507-5841, Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. E-mail: aaharky@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-5507-5841
                Article
                DOI: 10.21470/1678-9741-2018-0374
                PMC ID: 6894029
                PubMed ID: 31112031
                SO-VID: 72f2af8d-3877-486b-b702-ea576b5bcb42
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 November 2018
                Date accepted : 19 January 2019
                Categories
                Subject: Review Article

                Keywords: aortic valve stenosis – etiology,young adult,transcatheter aortic valve replacement – methods
                Data availability:
                Keywords: aortic valve stenosis – etiology, young adult, transcatheter aortic valve replacement – methods

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