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Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years

Stoica, Serban; Beard, Chloe; Takkenberg, Johanna J M; Mokhles, Mostafa M; Turner, Mark; Pepper, John; Hopewell-Kelly, Noreen; Benedetto, Umberto; Nashef, Samer A M; El-Hamamsy, Ismail; Skillington, Peter; Glauber, Mattia; De Paulis, Ruggero; Tseng, Elaine; Meuris, Bart; Sitges, Marta; Delgado, Victoria; Krane, Markus; Kostolny, Martin; Pufulete, Maria

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Authors

Serban Stoica

Chloe Beard

Johanna J M Takkenberg

Mostafa M Mokhles

Mark Turner

John Pepper

Umberto Benedetto

Samer A M Nashef

Ismail El-Hamamsy

Peter Skillington

Mattia Glauber

Ruggero De Paulis

Elaine Tseng

Bart Meuris

Marta Sitges

Victoria Delgado

Markus Krane

Martin Kostolny

Maria Pufulete



Abstract

Objective: There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure. Methods: A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting). Results: There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span). Conclusions: Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.

Journal Article Type Article
Acceptance Date Dec 12, 2022
Online Publication Date Feb 27, 2023
Publication Date May 15, 2023
Deposit Date May 18, 2023
Publicly Available Date May 18, 2023
Journal Heart
Print ISSN 1355-6037
Electronic ISSN 1468-201X
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 109
Pages 857-865
DOI https://doi.org/10.1136/heartjnl-2022-321740
Keywords Aortic and vascular disease, heart valve prosthesis, transcatheter aortic valve replacement, aortic valve insufficiency, aortic valve stenosis, heart valve prosthesis implantation
Public URL https://uwe-repository.worktribe.com/output/10537602
Publisher URL https://heart.bmj.com/content/early/2023/02/26/heartjnl-2022-321740

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