2021 ESC/EACTS Guidelines for the management of valvular heart disease

Vahanian, Alec; Beyersdorf, Friedhelm; Neumann, Franz‐Josef; Myers, Patrick Olivier; Abdelhamid, Magdy; Asteggiano, Riccardo; Barili, Fabio; Borger, Michael A.; Carrel, Thierry; Collet, Jean‐Philippe; Foldager, Dan; Habib, Gilbert; Hassager, Christian; Irs, Alar; Iung, Bernard; Jahangiri, Marjan; Katus, Hugo A.; Koskinas, Konstantinos C.; Maßberg, Steffen; Mueller, Christian; Nielsen, Jens Cosedis; Pîbarot, Philippe; Rakisheva, Amina; Roffi, Marco; Rubboli, Andrea; Shlyakhto, Evgeny; Siepe, Matthias; Sitges, Marta; Søndergaard, Lars; Sousa‐Uva, Miguel; Tarantini, Guiseppe; Zamorano, José Luís; Praz, Fabien; Milojevic, Milan; Baldus, Stephan; Bauersachs, Johann; Capodanno, Davide; Conradi, Lenard; Bonis, Michele De; Paulis, Ruggero De; Delgado, Victoria; Freemantle, Nick; Gilard, Martine; Haugaa, Kristina H; Jeppsson, Anders; Jüni, Peter; Piérard, Luc; Prendergast, Bernard; Sádaba, J Rafael; Tribouilloy, Christophe; Wojakowski, Wojtek; Benchabi, Yasmina; Chilingaryan, A.; Metzler, Bernhard; Rustamova, Yasmin; Shumavets, V; Lancellotti, Patrizio; Smajić, Elnur; Trendafilova‐Lazarova, Diana; Samardžić, Jure; Karakyriou, Maria; Paleček, Tomáš; Dahl, Jordi S.; Meshaal, Marwa Sayed; Palm, Kairit; Virtanen, Marko; Bouleti, Claire; Bakhutashvili, Z; Achenbach, Stephan; Boutsikou, Maria; Kertész, Attila; Daníelsen, Ragnar; Topilsky, Yan; Golino, Paolo; Tuleutayev, Rustem M.; Elezi, Shpend; Kerimkulov, Alina; Rudzītis, Ainārs; Glaveckaitė, Sigita; Sow, Rouguiatou; Demarco, Daniela Cassar; Bulatović, Nebojša; Aouad, A.; Brink, Renée van den; Antova, Emilija; Beitnes, Jan Otto; Ochała, Andrzej; Ribeiras, Regina; Vinereanu, Dragoş; Irtyuga, Olga; Ivanović, Branislava; Šimková, Iveta; Gómez, Ariana González; Sarno, Giovanna; Pedrazzini, Giovanni; Bsata, Walid; Zakhama, Lilia; Korkmaz, Levent; Cherniuk, S. V.; Khanji, Mohammed Y; Sharipov, Islamjan

doi:10.1093/eurheartj/ehab395

Cited by 3,272 publications

(2,475 citation statements)

References 571 publications

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“…However, contrary to our results, patients enrolled had higher LVEF (56.6% in the invasive arm and 59.2% in the conservative arm) [4]. Current ESC guidelines for the treatment of valvular heart disease allow BAV to be performed in such patients with class IIb recommendation [2].…”

Section: Discussioncontrasting

confidence: 97%

“…At present, management of severe aortic valve stenosis (AS) offers surgical or endovascular therapy depending on a patients' risk profile and severity of clinical symptoms [1,2]. Endovascular treatment includes transcatheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV).…”

Section: Introductionmentioning

confidence: 99%

“…Balloon aortic valvuloplasty has gained importance in recent years, especially in patients who were recognized as in not optimal clinical condition for any definitive treatment due to severe comorbidities. Baloon valvuloplasty can either serve as a standalone palliative procedure performed in haemodynamicaly unstable patients or as a bridge to final therapy [1][2][3]. Furthermore, BAV allows AS patients to undergo an urgent non-cardiac surgery with its good immediate hemodynamic result [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…On the contrary to TAVI, clinical and hemodynamic outcomes of BAV were shown to be relatively poor with longer follow-up period, and sometimes the procedure needs to be repeated [4][5][6][7][8]. Due to relatively low access to TAVI, BAV is still a reasonable procedure in developing countries, but such an approach remains rather controversial in light of current ESC guidelines [2]. Thus, we aimed to assess patient flow, procedural complications and clinical outcomes after BAV as rescue or bridge therapy in patients with severe symptomatic AS.…”

Section: Introductionmentioning

confidence: 99%

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Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Kleczyński

Kulbat

Brzychczy

et al. 2021

JCM

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The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55–2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62–3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.

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Section: Discussioncontrasting

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Kleczyński

Kulbat

Brzychczy

et al. 2021

JCM

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“…AS commonly leads to left ventricular (LV) pressure overload resulting in concentric hypertrophy that prevents symptom onset for a long time while yielding progressive left and right ventricular dysfunction and impaired survival [3,4]. Current guidelines recommend intervention in patients with AS according to the severity of the disease and the presence of the symptoms [5,6]. However, the benefits of valve replacement may be limited in patients with advanced functional and structural myocardial changes.…”

Section: Introductionmentioning

confidence: 99%

Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Avvedimento

Franzone

Leone

et al. 2021

JCM

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(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.

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Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair

Kasim

2023

JAMA

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ImportanceThe safety and effectiveness of mitral valve repair via thoracoscopically-guided minithoracotomy (minithoracotomy) compared with median sternotomy (sternotomy) in patients with degenerative mitral valve regurgitation is uncertain.ObjectiveTo compare the safety and effectiveness of minithoracotomy vs sternotomy mitral valve repair in a randomized trial.Design, Setting, and ParticipantsA pragmatic, multicenter, superiority, randomized clinical trial in 10 tertiary care institutions in the UK. Participants were adults with degenerative mitral regurgitation undergoing mitral valve repair surgery.InterventionsParticipants were randomized 1:1 with concealed allocation to receive either minithoracotomy or sternotomy mitral valve repair performed by an expert surgeon.Main Outcomes and MeasuresThe primary outcome was physical functioning and associated return to usual activities measured by change from baseline in the 36-Item Short Form Health Survey (SF-36) version 2 physical functioning scale 12 weeks after the index surgery, assessed by an independent researcher masked to the intervention. Secondary outcomes included recurrent mitral regurgitation grade, physical activity, and quality of life. The prespecified safety outcomes included death, repeat mitral valve surgery, or heart failure hospitalization up to 1 year.ResultsBetween November 2016 and January 2021, 330 participants were randomized (mean age, 67 years, 100 female [30%]); 166 were allocated to minithoracotomy and 164 allocated to sternotomy, of whom 309 underwent surgery and 294 reported the primary outcome. At 12 weeks, the mean between-group difference in the change in the SF-36 physical function T score was 0.68 (95% CI, −1.89 to 3.26). Valve repair rates (≈ 96%) were similar in both groups. Echocardiography demonstrated mitral regurgitation severity as none or mild for 92% of participants at 1 year with no difference between groups. The composite safety outcome occurred in 5.4% (9 of 166) of patients undergoing minithoracotomy and 6.1% (10 of 163) undergoing sternotomy at 1 year.Conclusions and relevanceMinithoracotomy is not superior to sternotomy in recovery of physical function at 12 weeks. Minithoracotomy achieves high rates and quality of valve repair and has similar safety outcomes at 1 year to sternotomy. The results provide evidence to inform shared decision-making and treatment guidelines.Trial Registrationisrctn.org Identifier: ISRCTN13930454

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2021 ESC/EACTS Guidelines for the management of valvular heart disease

Cited by 3,272 publications

References 571 publications

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair

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