Aortic Valve Surgery in Non-Elderly Patients: Insights Gained from AVIATOR

Abstract We are currently in an era of change in management and shared decision-making for heart valvedisease. Aortic valvesurgery 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 valveintervention, the longer their anticipated life expectancywill be. This fact alone poses the biggest challenge to any aortic valveprocedure – i.e. longer anticipated life expectancymeans 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 valvepatients. 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