Therapeutic Controversies in the Medical Management of Valvular Heart Disease

Abstract

Objective: To evaluate the evidence for common therapeutic controversies in the medical management of valvular heart disease (VHD). Data Sources: A literature search of PubMed (inception to December 2020) was performed using the terms angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and adrenergic β-antagonists and aortic valve regurgitation (AR) or mitral stenosis (MS). Study Selection and Data Extraction: Randomized controlled trials (RCTs) and meta-analyses conducted in humans and published in English that reported ≥1 clinical outcome were included. Data Synthesis: Nine articles were included: 3 RCTs and 1 meta-analysis for ACE inhibitors/ARBs in AS, 1 RCT for β-blockers in AR, and 4 RCTs for β-blockers in MS. Evidence suggests that ACE inhibitors/ARBs do not increase the risk of adverse outcomes in patients with AS but may delay valve replacement. β-Blockers do not appear to worsen outcomes in patients with chronic AR and may improve left-ventricular function in patients with a reduced ejection fraction. β-Blockers do not improve and may actually worsen exercise tolerance in patients with MS in sinus rhythm. Relevance to Patient Care and Clinical Practice: ACE inhibitors/ARBs and β-blockers can likely be safely used in patients with AS or AR, respectively, who have a compelling indication. There is insufficient evidence to recommend routine use of β-blockers in patients with MS without atrial fibrillation. Conclusions: Common beliefs about the medical treatment of VHD are not supported by high-quality data. There remains a need for larger-scale RCTs in the medical management of VHD.

Effect of β‐blocker on patients with moderate functional mitral regurgitation undergoing surgical aortic valve replacement

“…Barry et al . also reports in their review that BB has barely affects the outcomes of patients with aortic insufficiency and normal EF 20 . Notably, however, we have included patients with various levels of EF regardless of their classifications of heart failure in this study, whereas the majority of patients acquired preserved or even numerically normal EF.…”

“…Recent study even shows that the use of BB is associated with better outcomes in patients undergoing cardiac surgery 11,12 . However, debates still exist for the usage of BB in patients with valvular heart disease 20 . Although a large number of patients complicated with severe aortic valve disease receive BB therapy after the surgery in the clinical practice, researchers report that these medications might increase the mortality in patients with severe chronic non‐ischaemic mitral regurgitation 13 .…”

Predictors of Mortality Following Aortic Valve Replacement in Aortic Stenosis Patients

“…The choice of surgical intervention approach and surgery timing are based on a comprehensive decision based on examination results, surgery risk, presence of concomitant pathology and a patient’s fragility. The decision is made by the multidisciplinary team including a cardiologist, a cardiac surgeon, an X-ray endovascular surgeon, and a diagnostician [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Aortic valve replacement is recommended for most patients with severe aortic stenosis, whereas conservative treatment neither improves survival, nor slows down the progression of this defect [ 4 , 6 , 7 ].…”

“…The decision is made by the multidisciplinary team including a cardiologist, a cardiac surgeon, an X-ray endovascular surgeon, and a diagnostician [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Aortic valve replacement is recommended for most patients with severe aortic stenosis, whereas conservative treatment neither improves survival, nor slows down the progression of this defect [ 4 , 6 , 7 ]. Surgical aortic valve replacement (SAVR) of the affected valve represents standard treatment in the low risk group of patients (<75 years and STS-PROM/EuroSCORE II < 4%) or in patients who are operable and unsuitable for transcatheter aortic valve implantation (TAVI).…”

Surface Modification of Decellularized Heart Valve by the POSS–PEG Hybrid Hydrogel to Prepare a Composite Scaffold Material with Anticalcification Potential

“…Valvular heart disease (VHD) is a global problem that endangers human health seriously , and has an estimated prevalence of 2 to 3% in the United States adult population . The primary treatment for this disease is currently valve replacement. , Mechanical valves and bioprostheses are two commonly used valve substitutes in the clinic, but both of these two substitutes have defects that cannot be ignored and cannot be solved.…”