European Journal of Cardiovascular Medicine

Determining operability in patients with aortic valve disease is dependent on two major factors: The extent of damage induced by strain on the myocardium from stenotic and regurgitant lesions and technical and anatomical considerations related to the surgical procedure itself. The decision t intervention. Indications recommend performing corrective procedures before establishment of severe myocardial damage. Thus the treating physician may believe that it is too late to refer a co-morbidities, and when myocardial contractile reserve is poor.On the other hand, the surgeon may be reluctant to perform the intervention in the presence of technical challenges. In either case, management of valve disease has witnessed major advances permitting surgical intervention in these high-risk patients. Anaesthetic care has improved with perioperative and intensive care protocols allowing better preparation of patients for the surgical procedure and smoother postoperative periods. Surgical techniques have become less aggressive better myocardial protection. Recently, transcatheter techniques allowing endovascular access precluding the need for cardiopulmonary bypass and aortic cross clamping altogether have opened new horizons in patients for whom technical complexity would contraindicate the procedure or the centre experience, available technology and should be taken by a heart team including surgeons, cardiologists and anaesthesiologists.