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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 treatmen...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314052/ https://www.ncbi.nlm.nih.gov/pubmed/36849232 http://dx.doi.org/10.1136/heartjnl-2022-321740 |
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author | 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 |
author_facet | 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 |
author_sort | Stoica, Serban |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10314052 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-103140522023-07-02 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 Heart Valvular Heart Disease 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. BMJ Publishing Group 2023-06 2023-02-27 /pmc/articles/PMC10314052/ /pubmed/36849232 http://dx.doi.org/10.1136/heartjnl-2022-321740 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Valvular Heart Disease 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 Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title | Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title_full | Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title_fullStr | Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title_full_unstemmed | Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title_short | Formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
title_sort | formal consensus study on surgery to replace the aortic valve in adults aged 18–60 years |
topic | Valvular Heart Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314052/ https://www.ncbi.nlm.nih.gov/pubmed/36849232 http://dx.doi.org/10.1136/heartjnl-2022-321740 |
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