Cardiology

AHA/ACC Update Heart Valve Disease Guidelines

The American Heart Association (AHA) and American College of Cardiology (ACC) recently released recommendations updating the 2014 guidelines on the management and care of adult patients with valvular heart disease.

Changes to the recommendations were based on a systematic review of randomized controlled trials published between October 2013 and November 2016. “Major areas of change include indications for transcatheter aortic valve replacement (TAVR), surgical management of the patient with primary and secondary mitral regurgitation (MR), and management of patients with valve prostheses,” the guidelines stated.
_______________________________________________________________________________________________________________________________________________________
RELATED CONTENT
What is The Role of LDL in Aortic Valve Stenosis?
Successful Valve-in-Valve Transcatheter Aortic Valve Replacement in a Nonagenarian With a Degenerated Bioprosthetic Prosthesis
______________________________________________________________________________________________________________________________________________________

Among the recommendations:

  • The AHA and ACC strongly recommend anticoagulation for treating patients with atrial fibrillation (AF) and a CHA2DS2-VASc score of 2 or greater with native aortic valve disease, tricuspid valve disease, or MR.
  • Mitral valve surgery was considered reasonable for treating asymptomatic patients with chronic primary MR (stage C1) and preserved left ventricular (LV) function (LV ejection fraction [LVEF] >60% and LV end-systolic diameter [LVESD] <40 mm) with progressive increases in LV size or decreases in ejection fraction.
  • The age limit for an aortic or mitral mechanical prosthesis was lowered from 60 to 50 years of age and treatment with mechanical prosthesis was considered reasonable for patients without contraindications to anticoagulation.
  • Direct oral anticoagulants were considered reasonable as an alternative to vitamin K antagonists for treating patients with AF and native aortic valve disease, tricuspid valve disease, or MR and a CHA2DS2-VASc score of 2 or greater.

In addition, the guidelines include new or modified recommendations on the treatment of infective endocarditis in patients after an intracranial hemorrhage or stroke, evaluation and treatment of mechanical prosthetic valve thrombosis, and treatment of patients with prosthetic valve stenosis.

—Melissa Weiss

Reference:

Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online March 15, 2017]. Circulation. doi:10.1161/CIR.0000000000000503.