Discrepancy in guidelines for the prevention of thrombo-embolism in patients with prosthetic heart valves: reply

Vahanian, Alec

doi:10.1093/eurheartj/ehm354

Cited by 34 publications

(7 citation statements)

References 4 publications

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“…Consequently, assessment of stenosis severity in asymptomatic patients with AS should not rely on a single parameter but on a multiparametric approach incorporating data derived from transaortic gradients and velocities in addition to less flow‐dependent indices such as AVA. AVR may be a biased end point because the physician referring the patient to AVR knew the results of the AVA and gradient; however, the surgical decisions were made by the heart teams of the 2 tertiary centers in accordance with practice guidelines,19 and we observed a comparable delay between inclusion and AVR in patients with an AVA ≤0.6 cm 2 , 0.6 to 0.8 cm 2 , and 0.8 to 1.0 cm 2 . Moreover, we found excess mortality in patients with an AVA ≤0.6 cm 2 compared with patients with mild to moderate AS, whereas no excess mortality was noted in patients with an AVA 0.6 to 0.8 cm 2 or 0.8 to 1.0 cm 2 , reinforcing the prognostic importance of AVA in the setting of patients with asymptomatic severe AS.…”

Section: Discussionmentioning

confidence: 99%

“…The outcome end points were time to occurrence of all‐cause death or need for AVR and all‐cause death regardless of whether or not there was AVR, respectively. Clinical decisions regarding medical management and referral for surgery were made by the heart team with the approval of the patient's cardiologist based on ESC guidelines 19, 20. Indications for AVR were occurrence during follow‐up of symptoms, left ventricular dysfunction (LVEF <50%), or symptoms during an exercise test.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Maréchaux

Ringlé

Ruşinaru

et al. 2016

JAHA

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BackgroundThe aim of this study was to evaluate the relationship between aortic valve area (AVA) obtained by Doppler echocardiography and outcome in patients with severe asymptomatic aortic stenosis and to define a specific threshold of AVA for identifying asymptomatic patients at very high risk based on their clinical outcome.Methods and ResultsWe included 199 patients with asymptomatic severe aortic stenosis (AVA ≤1.0 cm2). The risk of events (death or need for aortic valve replacement) increased linearly on the scale of log hazard with decreased AVA (adjusted hazard ratio 1.17; 95% CI 1.06–1.29 per 0.1 cm2 AVA decrement; P=0.002). Event‐free survival at 12, 24, and 48 months was 63±6%, 51±6%, and 34±6%, respectively, for AVA 0.8 to 1 cm2; 49±6%, 36±6%, and 26±6%, respectively, for AVA 0.6 to 0.8 cm2; and 33±8%, 20±7%, and 11±5%, respectively, for AVA ≤0.6 cm2 (P trend=0.002). Patients with AVA ≤0.6 cm2 had a significantly increased risk of events compared with patients with AVA 0.8 to 1 cm2 (adjusted hazard ratio 2.22; 95% CI 1.41–3.52; P=0.001), whereas patients with AVA 0.6 to 0.8 cm2 had an increased risk of events compared with those with AVA 0.8 to 1 cm2, but the difference was not statistically significant (adjusted hazard ratio 1.38; 95% CI 0.93–2.05; P=0.11). After adjustment for covariates and aortic valve replacement as a time‐dependent variable, patients with AVA ≤0.6 cm2 had a significantly greater risk of all‐cause mortality than patients with AVA >0.6 cm2 (hazard ratio 3.39; 95% CI 1.80–6.40; P<0.0001).ConclusionsPatients with severe asymptomatic aortic stenosis and AVA ≤0.6 cm2 displayed an important increase in the risk of adverse events during short‐term follow‐up. Further studies are needed to determine whether elective aortic valve replacement improves outcome in this high‐risk subgroup of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Maréchaux

Ringlé

Ruşinaru

et al. 2016

JAHA

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“…The 2007 European Society of Cardiology (ESC) guidelines [8] recommend initial follow up 6-12 weeks post operatively with TTE imaging. Thereafter, yearly clinical assessment is prudent and repeat TTE imaging is dependent on development of new cardiac symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…According to the 2007 ESC guidelines [8], once valve thrombosis reaches clinically significant obstruction, management between anticoagulation and surgery rests on the level of critical illness. Surgery is performed in critically ill patients unless it is not immediately available or in patients unlikely to survive surgery due to significant co-morbidities, where fibrinolysis is considered as an alternative.…”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure: a case report

Saeed

Williams

et al. 2010

J Cardiothorac Surg

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Occurrence of bioprosthetic valve thrombosis less than a year after replacement is very uncommon. Here, we describe a case of a 57 year old male, who presented 10 months after receiving a bioprosthetic mitral valve replacement with a two week history of dyspnea on exertion, worsening orthopnea and decreased exercise tolerance. Echocardiography revealed severe mitral regurgitation (MR), thrombosis of the posterior mitral leaflet, left atrial (LA) mural thrombus and a depressed left ventricular ejection fraction of twenty-five percent. Given severe clot burden and decompensated heart failure (New York Heart Association - NYHA class III) repeat sternotomy was done to replace the bioprosthetic mitral valve and remove LA mural thrombus. MR was resolved postoperatively. This brief report further reviews promoting factors, established guidelines and management strategies of bioprosthetic valve thrombosis.

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“…The use of these latter peptides for the assessment of cardiovascular risk, the diagnosis and the management of patients is currently included in cardiovascular guidelines while AVP and other neurohormonal markers (aldosterone, norepinephrine, renin or endothelin) are not [3,7]. Indeed, natriuretic peptides are the only biomarkers suggested for the management of valvular heart disease [8]. Beyond cardiopathies, high levels of (atrial) natriuretic peptides are also associated with advanced patient age and renal impairment [9].…”

Section: Introductionmentioning

confidence: 99%

Copeptin in Mitral Balloon Valvuloplasty: A New Approach in Valvular Interventions?

Cokkinos¹,

Belogianneas²

2012

Cardiology

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Discrepancy in guidelines for the prevention of thrombo-embolism in patients with prosthetic heart valves: reply

Cited by 34 publications

References 4 publications

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure: a case report

Copeptin in Mitral Balloon Valvuloplasty: A New Approach in Valvular Interventions?

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