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Aortic Valve Repair in Young Patients

Cardiac surgeons and interventionalists at Penn Heart and Vascular are performing aortic valve repair in patients younger than 50 years of age. Wing to the difficulty of AV repair, these patients would formerly have received AV replacement with mechanical or bioprosthetic valves. Aortic valve repair and replacement are often performed to address bicuspid aortic valve disease with dilated aortic annulus, conjoined cusp prolapse or valve cusp perforation in the absence of stenosis. Aortic valve replacement is identified with a number of concerns, including the need for life-long anticoagulation therapy, an elevated risk of infection, chronic pain and the potential for the artificial valve to fail with time. Aortic valve repair has been demonstrated to have a number of advantages by comparison to valve replacement. Perhaps most prominent among these is that the native heart valve—with all of its hemodynamic benefits—is preserved. This means that the valve can be repaired again, if need be, or replaced at a later time. The durability of AV repair is comparable to that of replacement; moreover valve repairs are associated with a lower rate of infection, and preclude the need for blood thinning medications. For younger patients, the durability of valve repair and the lack of blood thinner therapy are key advantages. Blood thinners must be used with artificial valves to avoid the risk of blood clots and stroke, but are notorious for their risks, side effects and potential for interaction with foods with other drugs. Patients may also have contraindications to anticoagulation that prevent the use of these drugs.