Michal Hulman, Radovan Zacharovský
Operations for a diseased aortic valve belong to most frequently performed in cardiac surgery today. Currently there are available four basic types of compensations: the mechanical and biological prostheses (with or without a stent), aortic homograft and pulmonary autograft. Gold standard is a mechanical prosthesis, which has progressively evolved from the ball-valve prosthesis until nowadays bileaflet tilting prostheses. Despite progress in the development of materials and construction of prostheses there is still a need for anticoagulant therapy /in mechanical prostheses/. Recommendations for the use of biological prostheses indicate the lower age limit of 65 years. Younger patients should be considered a possible re-operation and exchange of the prosthesis. Homograft has not found wider application. At present it is rarely used for aortic valve replacement for infective endocarditis especially for native and prosthetic valves. Autograft is implantation of the pulmonary valve into the aortic root. Right ventricular outflow tract is reconstructed by pulmonary homograft or bioprostheses. Autograft disadvantages are technical difficulties and risk of reoperation in dilatation of autografts or degeneration of pulmonary homografts. At present, the development seeks to implant valves via transcatheter access.