The decision-making for surgical therapy in acquired valvular heart disease

The decision-making for surgery in patients with acquired valvular heart disease remains to be a difficult clinical problem despite the development of new invasive techniques like reconstructive valve surgery or balloon valvuloplasty. Basic studies, discussions and reflections about the indication for surgery are presented. In this regard, ethical and economic aspects as well as aspects of life quality are increasingly taken into account. While for the new surgical methods there are only studies about technical details as well as short-term postoperative results available, there are many pre-/postoperative studies including long-term results for the ''classic'' valve surgery ''valve replacement''. Furthermore, there exist some studies about the natural course. A framework about the decision-making for valve surgery is presented. In this framework the results of these studies can be incorporated in a sophisticated manner. With this framework it can also be demonstrated how the new surgical techniques - as compared to classic valve replacement - are influencing the indication for valve surgery.