2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

Off-label Use of Direct Oral Anticoagulants in Patients Receiving Surgical Mechanical and Bioprosthetic Heart Valves

“…In patients with mechanical heart valves, use of direct oral anticoagulants (DOACs) is currently contraindicated, and their use in patients with bioprosthetic heart valves is off-label. 1,2 We sought to determine the current state of use of DOACs in patients with surgical prosthetic heart valves in the US and evaluate differences in preoperative and postoperative profiles among patients discharged while receiving DOACs vs warfarin.…”

Coronary Assessment and Revascularization Before Transcutaneous Aortic Valve Implantation: An Update on Current Knowledge

“…Moreover, it has been shown to be at least non-inferior to SAVR in elderly patients across all surgical risk profiles (9)(10)(11)(12)(13)(14)(15). According to the recently updated American and European guidelines, TAVI is the recommended treatment of symptomatic severe AS in patients aged 80 years or more and may be considered in patients aged 65-80 years based on patient/anatomical characteristics and shared decision-making (16,17). As a result, more patients are currently treated with TAVI than with SAVR in the Western world.…”

Should SGLT2i be used prior to transcatheter edge‐to‐edge repair for secondary mitral regurgitation?

“…Secondary mitral regurgitation (MR) in patients with heart failure with reduced ejection fraction (HFrEF) portends a poor prognosis when it occurs. 1 Left ventricular dilation leads to annular dilation of the mitral annulus and reduced coaptation of the mitral valve leaflets leading to secondary MR. Until recently, medical and cardiac resynchronization therapy was the primary treatment strategy for symptomatic secondary MR, with surgical repair reserved for select patients most often undergoing concomitant open heart surgery. The most recent American College of Cardiology/American Heart Association guidelines on the management of valvular heart disease now recommend (Class 2a) mitral valve transcatheter edge-to-edge repair (TEER)as a treatment option for many patients who remain symptomatic despite optimal guideline-directed medical therapy (GDMT).…”

“…There is overwhelming evidence that neurohormonal modulation by GDMT leads to reverse cardiac remodeling with resultant reduction in left ventricular size and volume, leading to reduction of MR severity and improvement in functional status. 1 Renin-angiotensinaldosterone system inhibitors (RAAS-I), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) have been the mainstays of GDMT for many years, and are proven to reverse cardiac remodeling, promoting improvements in New York Heart Association class and mortality among patients with HFrEF.…”