2014 AHA/ACC guideline for the management of patients with valvular heart disease

Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blasé A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D.; Anderson, Jeffrey L.; Halperin, Jonathan L.; Albert, Nancy M.; Bozkurt, Biykem; Brindis, Ralph G.; Creager, Mark A.; Curtis, Lesley H.; DeMets, David L.; Hochman, Judith S.; Kovacs, Richard J.; Ohman, E. Magnus; Pressler, Susan J.; Sellke, Frank W.; Shen, Win Kuang; Stevenson, William G.; Yancy, Clyde W.

doi:10.1016/j.jtcvs.2014.05.014

Cited by 955 publications

(448 citation statements)

References 867 publications

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“…However, the relationship between hypercholesterolemia and CAVD is more ambiguous. Whereas hypercholesterolemia is a risk factor for CAVD, lipid‐lowering techniques do not significantly reduce CAVD incidence 21, 22, 23. In both heterozygous FH and HoFH, CAVD prevalence is significantly higher than in the normotypic population, but still occurs at a greatly reduced rate relative to the development of atherosclerosis in FH individuals 1, 8, 9, 39.…”

Section: Discussionmentioning

confidence: 99%

“…The many conflicting reports on the use of statins (3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitors) to prevent or treat CAVD serve to illustrate this point 14, 15, 16. Although these LDL‐lowering drugs are considered an effective therapy for reducing the incidence or severity of CAD in both FH17, 18 and non‐FH populations,19, 20 randomized, prospective trials have failed to yield evidence that statins are effective at reducing the progression of CAVD 21, 22, 23. Even in individuals with FH, it remains unclear to what extent elevated LDL levels may contribute to initiation or progression of aortic valve disease.…”

Section: Introductionmentioning

confidence: 99%

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Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology

Porras

Shanmuganayagam

Meudt

et al. 2015

JAHA

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BackgroundFamilial hypercholesterolemia (FH) is a prevalent hereditary disease associated with increased atherosclerosis and calcific aortic valve disease (CAVD). However, in both FH and non‐FH individuals, the role of hypercholesterolemia in the development of CAVD is poorly understood. This study used Rapacz FH (RFH) swine, an established model of human FH, to investigate the role of hypercholesterolemia alone in the initiation and progression of CAVD. The valves of RFH swine have not previously been examined.Methods and ResultsAortic valve leaflets were isolated from wild‐type (0.25‐ and 1‐year‐old) and RFH (0.25‐, 1‐, 2‐, and 3‐year‐old) swine. Adult RFH animals exhibited numerous hallmarks of early CAVD. Significant leaflet thickening was found in adult RFH swine, accompanied by extensive extracellular matrix remodeling, including proteoglycan enrichment, collagen disorganization, and elastin fragmentation. Increased lipid oxidation and infiltration of macrophages were also evident in adult RFH swine. Intracardiac echocardiography revealed mild aortic valve sclerosis in some of the adult RFH animals, but unimpaired valve function. Microarray analysis of valves from adult versus juvenile RFH animals revealed significant upregulation of inflammation‐related genes, as well as several commonalities with atherosclerosis and overlap with human CAVD.ConclusionsAdult RFH swine exhibited several hallmarks of early human CAVD, suggesting potential for these animals to help elucidate CAVD etiology in both FH and non‐FH individuals. The development of advanced atherosclerotic lesions, but only early‐stage CAVD, in RFH swine supports the hypothesis of an initial shared disease process, with additional stimulation necessary for further progression of CAVD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology

Porras

Shanmuganayagam

Meudt

et al. 2015

JAHA

View full text Add to dashboard Cite

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“…Published data on long‐term outcomes in elderly patients are contradictory, and the cohorts of MV‐repair and MVR in these reports often were not comparable 7, 10, 11, 12. While European and American guidelines in general favor MV‐repair over MVR, if a durable repair can be achieved, European guidelines do not address the elderly population with MV disease,13 and American guidelines recommend MV‐repair in patients >65 years only in the presence of symptomatic primary MV disease 14…”

Section: Introductionmentioning

confidence: 99%

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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BackgroundBecause of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years.Methods and ResultsOur in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03).ConclusionsExcellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.

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“…(26) The AHA/ACC 2014 valvular heart disease guidelines recommend warfarin in patients for MS and AF, prior embolic stroke in sinus rhythm and/or left atrial thrombus (Class IB). (27) These guidelines also state that warfarin for asymptomatic patients with severe MS and LA dimension >55mm, or enlarged LA with spontaneous echo contrast on echocardiogram, is controversial.…”

Section: What Do the Guidelines Recommend?mentioning

confidence: 99%

Management of rheumatic atrial fibrillation

Chin

2017

SAHJ

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2014 AHA/ACC guideline for the management of patients with valvular heart disease

Cited by 955 publications

References 867 publications

Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology

Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Management of rheumatic atrial fibrillation

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