AHA/ACC: 2017 Update to Guidelines for Valvular Heart Disease Managmenet

HealthDay News — The American Heart Association and American College of Cardiology have updated guidelines for the management of patients with valvular heart disease, according to a report published online in Circulation.

Rick A. Nishimura, MD, from the Mayo Clinic in Rochester, Minn., and colleagues reviewed current evidence and updated recommendations for the diagnosis and management of adult patients with valvular heart disease.

The researchers presented modified recommendations for open heart surgical aortic valve replacement (AVR) and transcatheter aortic valve replacement (TAVR). In accordance with the 2014 recommendations, the guidelines recommend that a multidisciplinary group of health care professionals should collaborate to provide optimal care for patients in whom TAVR or high-risk surgical AVR is being considered; surgical AVR is recommended for people with advanced aortic stenosis who have low or intermediate surgical risk for either symptoms or indications of future problems. TAVR is a reasonable alternative to surgical replacement for patients with advanced aortic stenosis who have symptoms and are at intermediate or high surgical risk. A shared decision-making approach should be used when considering replacement of a faulty valve. The guideline also modified recommendations regarding which patients with risk of infective endocarditis should receive antibiotics before certain dental procedures.

“Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment,” the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [published online March 15, 2017]. Circulation. doi: 10.1161/CIR.0000000000000503