Abstract
We are currently in an era of change in management and shared decision-making for heart valve disease. Aortic valve surgery in non-elderly patients represents a very challenging patient population.
Their high level of physical activity places haemodynamic demands on the valve. Their post-operative quality of life is extremely important, and must be compatible with their professional and personal lifestyle.
More importantly, the younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be. This fact alone poses the biggest challenge to any aortic valve procedure - i.e. longer anticipated life expectancy means longer exposure to valve-related complications such as degeneration, need for re-operation, bleeding and thromboembolism.
Unlike what is found in older patients, aortic insufficiency (AI) is very common in the younger aortic valve patients. More than 50% of AI cases are in patients under the age of 50 years, and these patients with AI have an impaired survival compared to those with aortic stenosis.1