In the older child and young adult with aortic valve disease requiring surgery, I find myself in the uncomfortable position of trying to explain to the patient, or rather usually the patient's parents, the options for aortic valve substitutes. Usually a lengthy discussion ensues about the pros and cons of each option, including valve repair, mechanical valves, the Ross operation, and rarely biologic valves. The reason that this discussion is uncomfortable is because it exposes to the parents, to the patients, and to me that there are many unanswered questions.
