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Valvular Heart Disease: Difference between revisions
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!Current Guidelines | !Current Guidelines | ||
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|'''Indications for aortic valve replacement:''' | |||
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|'''Class I''' | |'''Class I''' | ||
#AVR is indicated for symptomatic patients with severe AS. (Level of Evidence: B) | #AVR is indicated for symptomatic patients with severe AS. (Level of Evidence: B) | ||
#AVR is indicated for patients with severe AS undergoing coronary artery bypass graft surgery (CABG). | #AVR is indicated for patients with severe AS undergoing coronary artery bypass graft surgery (CABG). (Level of Evidence: C) | ||
#AVR is indicated for patients with severe AS undergoing surgery on the aorta or other heart valves. (Level of Evidence: C) | |||
#AVR is indicated for patients with severe AS undergoing surgery on the aorta or other heart valves. (Level | #AVR is recommended for patients with severe AS and LV systolic dysfunction (ejection fraction less than 0.50). (Level of Evidence: C) | ||
of Evidence: C) | |||
#AVR is recommended for patients with severe AS and LV systolic dysfunction (ejection fraction less than | |||
0.50). (Level of Evidence: C) | |||
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|'''Class IIa''' | |'''Class IIa''' | ||
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|Class IIb | |Class IIb | ||
#AVR may be considered for asymptomatic patients with severe AS and abnormal response to exercise | #AVR may be considered for asymptomatic patients with severe AS and abnormal response to exercise (e.g., development of symptoms or asymptomatic hypotension). (Level of Evidence: C) | ||
(e.g., development of symptoms or asymptomatic hypotension). (Level of Evidence: C) | |||
#AVR may be considered for adults with severe asymptomatic AS if there is a high likelihood of rapid progression (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset. (Level of Evidence: C) | #AVR may be considered for adults with severe asymptomatic AS if there is a high likelihood of rapid progression (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset. (Level of Evidence: C) | ||
#AVR may be considered in patients undergoing CABG who have mild AS when there is evidence, such as moderate to severe valve calcification, that progression may be rapid. (Level of Evidence: C) | #AVR may be considered in patients undergoing CABG who have mild AS when there is evidence, such as moderate to severe valve calcification, that progression may be rapid. (Level of Evidence: C) | ||
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=== Transcatheter intervention === | === Transcatheter intervention === | ||
In 2002, the first transcatheter aortic valve implantation was performed by Dr. Alain Cribier <cite>Cribier</cite>. A transcatheter aortic valve implantation is a less invasive treatment option for patients at prohibitive risk for conventional aortic valve replacement. In this technique, the native valve is not excised. After balloon valvuloplasty, the prosthetic valve is implanted in the aortic position, with the frame of the prosthesis covering the native valve. The bioprosthesis can be implanted retrograde or antegrade. Currently 4 different approaches may be used in this technique. (table…). Transcatheter aortic valve implantation is assessed in randomized clinical trials and registries. | |||
{| class="wikitable" border="1" | {| class="wikitable" border="1" cellpadding="0" cellspacing="0" | ||
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! | ! The current 4 different approaches are: | ||
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|Transfemoral, retrograde | |Transfemoral, retrograde | ||
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==== Chronic Aortic regurgitation ==== | ==== Chronic Aortic regurgitation ==== | ||
{| class="wikitable" border="1" | {| class="wikitable" border="1" cellpadding="0" cellspacing="0" | ||
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!Causes of chronic aortic regurgitation | !Causes of chronic aortic regurgitation | ||
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#Aortic root/annular dilation | #Aortic root/annular dilation | ||
#Congenital bicuspid valve | #Congenital bicuspid valve | ||
#Previous infective endocarditis | #Previous infective endocarditis | ||
#Rheumatic | #Rheumatic | ||
#In association with other diseases | #In association with other diseases | ||
|} | |} | ||
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|'''Class I''' | |'''Class I''' | ||
#Vasodilator therapy is indicated for chronic therapy in patients with severe AR who have symptoms or LV dysfunction when surgery is not recommended because of additional cardiac or noncardiac factors. (Level of Evidence: B) | |||
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|'''Class IIa''' | |'''Class IIa''' | ||
#Vasodilator therapy is reasonable for short-term therapy to improve the hemodynamic profile of patients with severe heart failure symptoms and severe LV dysfunction before proceeding with AVR. (Level of Evidence: C) | |||
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|'''Class IIb''' | |'''Class IIb''' | ||
#Vasodilator therapy may be considered for long-term therapy in asymptomatic patients with severe AR who have LV dilatation but normal systolic function. (Level of Evidence: B) | |||
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|'''Class III''' | |'''Class III''' | ||
#Vasodilator therapy is not indicated for long-term therapy in asymptomatic patients with mild to moderate AR and normal LV systolic function. (Level of Evidence: B) | |||
AR and normal LV systolic function. (Level of Evidence: B) | #Vasodilator therapy is not indicated for long-term therapy in asymptomatic patients with LV systolic dysfunction who are otherwise candidates for AVR. (Level of Evidence: C) | ||
#Vasodilator therapy is not indicated for long-term therapy in symptomatic patients with either normal LV function or mild to moderate LV systolic dysfunction who are otherwise candidates for AVR. (Level of Evidence: C) | |||
|} | |} | ||