CONTROVERSIES

27. Should the Ross procedure ever be performed?

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For: The Ross procedure provides excellent, long-term (sometimes lifelong) hemodynamic relief of aortic stenosis and avoids the need for mechanical valves, thus avoiding the need for anticoagulation. An additional benefit is the regenerative capacity of the aortic autograft; it may actually increase in size as the patient grows.
Against: The Ross procedure is a technically demanding operation and has a significant learning curve with high associated morbidity. The procedure destroys a normal pulmonary valve, thus potentially giving the patient two (instead of one) valve diseases.

28. Should a tissue valve be used in young adults between ages 15 and 30 years?

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For: Anticoagulation is not necessary for tissue valves placed in the aortic position; thus, the risk of significant bleeding complications in active patients is avoided. For women in the childbearing years, the advantages are very real.
Against: Early valve dysfunction secondary to valve calcification occurs more aggressively in younger patients; thus, valve replacement may be necessary before 10 years.

29. Should minimally invasive approaches to aortic valve replacement be attempted?

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For: Aortic valve replacement can be performed via a ministernotomy. This approach avoids a complete sternotomy and may improve cosmesis and decrease blood loss.
Against: Aortic valve replacement via conventional sternotomy is surprisingly well tolerated and has excellent long-term results. Comparative studies have identified no difference in quality of life between minimally invasive and conventional aortic valve replacement. Furthermore, long-term results of the minimally invasive approach are not yet available.

References
WEB SITE
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BIBLIOGRAPHY
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