May 13, 2014

Management of Heart Valve Disease Simplified (Video)

Guidelines recommend best approaches for each stage of severity

valve3_690x380

Dr. James Thomas, a member of the AHA/ACC writing committee, talks about the new AHA/ACC guidelines, for the treatment of valvular heart disease including treatment recommendations for 4 classifications (stages) of valve disease. Watch the video below:

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Management of heart valve disease has been simplified through updated guidelines issued in March by the American College of Cardiology and American Heart Association, with input from five additional professional groups.

Following the lead taken by the congestive heart failure guidelines, the writers of the new heart valve guidelines categorized heart valve disease and its treatment into four stages by disease progression:

Stage A – Patients at risk due to rheumatic fever or other risk factors

Stage B – Asymptomatic patients with progressive (mild-to-moderate) valve disease

Stage C – Asymptomatic patients with severe valve disease

Advertisement

Stage D – Patients with symptomatic, severe valve disease.

“Within each stage, we recommend appropriate intervals for follow-up with physicians and imaging tests such as echocardiography,” says James Thomas, MD, a staff cardiologist in Cleveland Clinic’s Heart & Vascular Institute with a specialty interest in echocardiography. Dr. Thomas served on the writing committee for the heart valve guidelines.

Earlier intervention advised

The new guidelines include a risk assessment tool that includes the Society of Thoracic Surgeons’ Predicted Risk of Mortality model (STS PROM), frailty, major organ system dysfunction and procedure impediments, including radiation damage and heavily calcified ascending aorta.

As the risks of surgical and percutaneous intervention have gone down, early intervention is now considered preferable in select patients. “Some patients with severe valve disease, who are not yet symptomatic, may be appropriate for early valve surgery, because their risk for this operation is low,” says Dr. Thomas.

Aortic valve replacement, for example, is recommended for asymptomatic patients with severe aortic stenosis and a left ventricular ejection fraction of less than 50 percent.

Leave advanced cases to the experts

As patients progress into the later stages of severity, a key recommendation is to consult with, or refer the patient to, a Heart Valve Center of Excellence, such as the one at Cleveland Clinic, where a team of experts is best able to define the best treatment for the individual.

The guidelines recommend the team include a cardiologist and surgeon (including a structural valve interventionist, if a catheter-based therapy is being considered), and in selected cases, cardiovascular imaging specialists, cardiovascular surgeons, anesthesiologists, and nurses, with expertise in the management and outcomes of patients with complex heart valve disease.

Advertisement

This team is able to understand the risk–benefit ratio of different treatment strategies, and is particularly beneficial in patients who have treatment options, such as the elderly high-risk patient with severe symptomatic aortic stenosis being considered for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement.

TAVR recommendations

Although surgical valve replacement remains the recommended treatment for patients with Stage D valve disease at low-to-intermediate surgical risk, the intervention is now recommended for patients who are at high risk for surgical valve replacement and who are expected to survive longer than 12 months—providing the decision is made by a multidisciplinary team of heart valve experts.

“It is essential that an experienced team take part in their assessment and plan of any high-risk valve patient,” says Dr. Thomas.

TAVR is not recommended when existing comorbidities would negate the expected benefit from correcting the aortic stenosis.

Improving guideline accessibility

In a busy practice, guidelines are only useful when the information can be easily accessed and dissected. To this end, the heart valve management guidelines are now available as an app for smartphones and tablets.

“We wanted to provide quick answers to questions, such as what you should do if you have a patient with severe mitral regurgitation, or a pregnant patient taking Coumadin. We hope the app will help clinicians better manage their patients with heart valve disease,” says Dr. Thomas.

Related Articles

21-HVI-2541213_chest-pain_650x450
December 14, 2021
New Guideline Helps Evaluate Risk in Patients With Chest Pain

Further acute testing not needed if ECG and high-sensitivity troponin are negative

20-HVI-1987645-scott-cameron-md-phd_650x450
November 6, 2020
New Head of Vascular Medicine Looks to Enhance Collaborative Caregiving

Scott Cameron, MD, PhD, also brings wide-ranging research interests to bear

20-HVI-1961368_Matthew-Thompson_650x450
September 30, 2020
Dr. Matthew Thompson Brings a Distinctly International Perspective to Endovascular Interventions

Pioneering U.K. vascular surgeon joins Cleveland Clinic

20-HVI-1961369-acute-stroke-in-brain_650x450
September 24, 2020
Stroke Risk in Cardiac Surgery: New Guidance for Averting a Dreaded Complication

AHA statement is first comprehensive document on perioperative stroke reduction

20-HVI-1896881 vascular-surgery-650×450
July 17, 2020
Cleveland Clinic Earns 3 Stars in Vascular Quality Initiative Registry Participation Program

Recognition reflects prioritization of long-term patient outcomes

20-HVI-1898975 Singh_Guidelines on CV imaging in athletes_CQD_650x450_993744768
June 15, 2020
First Formal Guidance Issued on Multimodality Cardiac Imaging in Young Athletes

Recommendations help distinguish exercise-induced remodeling from pathology

20-HVI-1894191-Primary-prevention-of-CVD-in-women
May 29, 2020
Guideline Update on Primary Cardiovascular Prevention in Women Takes on Conventional and Sex-Specific Risks

JACC review highlights factors unique to women, ways to tailor management

20-HVI-1892867-ablation-roundup-650×450
May 12, 2020
Trio of Studies at Virtual HRS Meeting Showcase Catheter Ablation Advances

Pushing the envelope in ablation of atrial fibrillation, ventricular tachycardia

Ad