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

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

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.

aortic valve insufficiency, aortic valve stenosis, heart valve prosthesis, heart valve prosthesis implantation, transcatheter aortic valve replacement
1355-6037
857-865
Stoica, Serban
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Beard, Chloe
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Takkenberg, Johanna J.M.
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Mokhles, Mostafa M.
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Turner, Mark
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Pepper, John
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Hopewell-Kelly, Noreen
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Benedetto, Umberto
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Nashef, Samer A M
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El-Hamamsy, Ismail
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Skillington, Peter
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Glauber, Mattia
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De Paulis, Ruggero
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Tseng, Elaine
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Meuris, Bart
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Sitges, Marta
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Delgado, Victoria
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Krane, Markus
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Kostolny, Martin
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Pufulete, Maria
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Stoica, Serban
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Beard, Chloe
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Takkenberg, Johanna J.M.
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Mokhles, Mostafa M.
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Turner, Mark
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Pepper, John
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Hopewell-Kelly, Noreen
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Benedetto, Umberto
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Nashef, Samer A M
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El-Hamamsy, Ismail
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Skillington, Peter
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Glauber, Mattia
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De Paulis, Ruggero
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Tseng, Elaine
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Meuris, Bart
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Sitges, Marta
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Delgado, Victoria
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Krane, Markus
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Kostolny, Martin
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Pufulete, Maria
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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 and Pufulete, Maria (2023) Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years. Heart, 109 (11), 857-865, [heartjnl-2022-321740]. (doi:10.1136/heartjnl-2022-321740).

Record type: Article

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.

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Accepted/In Press date: 12 December 2022
e-pub ahead of print date: 27 February 2023
Published date: 1 June 2023
Additional Information: Funding Information: The study was supported by research funds from LivaNova and Admedus. Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
Keywords: aortic valve insufficiency, aortic valve stenosis, heart valve prosthesis, heart valve prosthesis implantation, transcatheter aortic valve replacement

Identifiers

Local EPrints ID: 475925
URI: http://eprints.soton.ac.uk/id/eprint/475925
ISSN: 1355-6037
PURE UUID: 1ad6ca8a-2340-47d6-87d0-c82a1ac2558b

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Date deposited: 31 Mar 2023 16:32
Last modified: 17 Mar 2024 01:27

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Contributors

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

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