Guidelines on the management of valvular heart disease (version 2012)

Alfieri, Ottavio; Andreotti, Felicita; Antunes, Manuel J.; Barón-Esquivias, Gonzalo; Borger, Michael A.; Carrel, Thierry; Bonis, Michele De; Evangelista, Arturo; Falk, Volkmar; Iung, Bernard; Lancellotti, Patrizio; Piérard, Luc; Price, Susanna; Schäfers, Hans‐Joachim; Schuler, Gerhard; Stępińska, Janina; Swedberg, Karl; Takkenberg, Johanna J.M.; Otto, Catherine M; Zamorano, José Luís; Zembala, Marian; Bax, Jeroen J.; Baumgartner, Helmut; Ceconi, Claudio; Dean, Veronica; Deaton, Christi; Fagard, Robert; Funck‐Brentano, Christian; Hasdai, David; Hoes, Arno W.; Kirchhof, Paulus; Knuuti, Juhani; Kolh, Philippe; McDonagh, Theresa A.; Moulin, Cyril; Reiner, Željko; Sechtem, Udo; Sirnes, Per Anton; Tendera, Michał; Torbicki, Adam; Vahanian, Alec; Windecker, Stephan; Popescu, Bogdan A.; Segesser, Ludwig von; Badano, Luigi P.; Bunc, Matjaž; Claeys, Marc J.; Drinković, Nikša; Filippatos, Gerasimos; Habib, Gilbert; Kappetein, Arie Pieter; Kassab, Roland; Lip, Gregory Y.H.; Moat, Neil; Nickenig, Georg; Otto, Catherine M.; Pepper, John; Piazza, Nicolò; Pieper, Petronella G.; Rosenhek, Raphaël; Shuka, Naltin; Schwammenthal, Ehud; Schwitter, Juerg; Mas, Pilar Tornos; Trindade, Pedro T.; Walther, Thomas

doi:10.1093/eurheartj/ehs109

Cited by 3,195 publications

(996 citation statements)

References 220 publications

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“…In order to reduce TR and improve clinical outcome, interest in tricuspid annuloplasty (TA) during left heart valve surgery has increased in recent years3, 4, 5 and the number of tricuspid procedures has doubled during the past decade 6. Although TA has shown a satisfactory perioperative and 30‐day result, 10‐year survival is limited to 50% to 74% 7, 8, 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

Chen

Liu

Chan

et al. 2016

JAHA

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BackgroundTricuspid annuloplasty is increasingly performed during left heart valve surgery, but the long‐term clinical outcome postoperatively is not satisfactory. The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome.Methods and ResultsOne‐hundred thirty‐seven patients (age 61±11 years; men, 30%) who underwent tricuspid annuloplasty during left‐side valve surgery were enrolled. The mean pulmonary artery systolic pressure before surgery was 49±13 mm Hg and 32±15 mm Hg following surgery. Patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). A preoperative larger right ventricular (RV) geometry and tricuspid valve tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow‐up of 25 months. Kaplan–Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% CI =1.34–18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% CI =2.43–30.98; P<0.01) were independent factors associated with adverse events.ConclusionsThe present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients.

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Section: Introductionmentioning

confidence: 99%

Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

Chen

Liu

Chan

et al. 2016

JAHA

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“…Previous reports demonstrated that asymptomatic patients with very severe AS defined by V max >5.50 m/s have a very high risk of adverse events during a short‐term follow‐up 10. Consistently, current ESC and AHA/ACC guidelines consider elective AVR reasonable in asymptomatic patients with a low surgical risk (class 2a recommendation) when V max is >5 m/s (AHA/ACC) or >5.50 m/s (ESC) or when MPG is >60 mm Hg (AHA/ACC) 1, 2. Nevertheless, the ability of AVA obtained by Doppler echocardiography to identify a subgroup of asymptomatic patients with severe AS who are at very high risk of events during short‐term follow‐up has not been investigated.…”

Section: Introductionmentioning

confidence: 85%

“…Severe aortic stenosis (AS) is defined as an aortic valve area (AVA) of <1.0 cm 2 and/or a mean transaortic pressure gradient (MPG) of >40 mm Hg and/or a peak aortic jet velocity (V max ) of >4 m/s 1, 2. According to European Society of Cardiology (ESC) guidelines and American Heart Association (AHA) and American College of Cardiology (ACC) guidelines, only patients having severe AS associated with either symptoms by history or on exercise testing or left ventricular ejection fraction (LVEF) <50% have a class 1 indication for aortic valve replacement (AVR) 1, 2.…”

Section: Introductionmentioning

confidence: 99%

“…According to European Society of Cardiology (ESC) guidelines and American Heart Association (AHA) and American College of Cardiology (ACC) guidelines, only patients having severe AS associated with either symptoms by history or on exercise testing or left ventricular ejection fraction (LVEF) <50% have a class 1 indication for aortic valve replacement (AVR) 1, 2. Although symptoms secondary to AS seldom develop before the orifice area is reduced to <1 cm 2 , some patients with very severe narrowing of the aortic valve (<0.5 cm 2 ) may remain asymptomatic 3, 4.…”

Section: Introductionmentioning

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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“…Humans who acquire severe AS during adult life usually develop symptoms within 2 years 26. The clinical course is more diverse in patients with congenital AS, in whom symptom onset may be delayed for decades 27, 28.…”

Section: Discussionmentioning

confidence: 99%

Discovery of an Experimental Model of Unicuspid Aortic Valve

Weiß

Chu

Brooks

et al. 2018

JAHA

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BackgroundThe epithelial growth factor receptor family of tyrosine kinases modulates embryonic formation of semilunar valves. We hypothesized that mice heterozygous for a dominant loss‐of‐function mutation in epithelial growth factor receptor, which are Egfr Vel/+ mice, would develop anomalous aortic valves, valve dysfunction, and valvular cardiomyopathy.Methods and ResultsAortic valves from Egfr Vel/+ mice and control mice were examined by light microscopy at 2.5 to 4 months of age. Additional Egfr Vel/+ and control mice underwent echocardiography at 2.5, 4.5, 8, and 12 months of age, followed by histologic examination. In young mice, microscopy revealed anatomic anomalies in 79% of Egfr Vel/+ aortic valves, which resembled human unicuspid aortic valves. Anomalies were not observed in control mice. At 12 months of age, histologic architecture was grossly distorted in Egfr Vel/+ aortic valves. Echocardiography detected moderate or severe aortic regurgitation, or aortic stenosis was present in 38% of Egfr Vel/+ mice at 2.5 months of age (N=24) and in 74% by 8 months of age. Left ventricular enlargement, hypertrophy, and reversion to a fetal myocardial gene expression program occurred in Egfr Vel/+ mice with aortic valve dysfunction, but not in Egfr Vel/+ mice with near‐normal aortic valve function. Myocardial fibrosis was minimal or absent in all groups.ConclusionsA new mouse model uniquely recapitulates salient functional, structural, and histologic features of human unicuspid aortic valve disease, which are phenotypically distinct from other forms of congenital aortic valve disease. The new model may be useful for elucidating mechanisms by which congenitally anomalous aortic valves become critically dysfunctional.

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Guidelines on the management of valvular heart disease (version 2012)

Cited by 3,195 publications

References 220 publications

Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

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

Discovery of an Experimental Model of Unicuspid Aortic Valve

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