2017 ACC/AHA Focused Update of the Guideline for the Management of Patients with Valvular Heart Disease: key messages and future insights_West China Medical Journal

Authors：

Zhengang ZHAO ¹ ,  Jilaihawi Hasan ²

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Cardiology and Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York 10016, U.S.;

Corresponding author：

Jilaihawi Hasan, Email: hasanjilaihawi@gmail.com

Keywords：

Valvular heart disease; Transcatheter valve therapy; Antithrombotic treatment; Focused updates of guideline

DOI：

10.7507/1002-0179.201801144

Video：

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There has been substantial progress in the field since the publication of the 2014 American College of Cardiology /American Heart Association Guideline for the Management of Valvular Heart Disease, thus mandating a timely update. Major modifications that were highlighted in the 2017 Focused Update include the treatment choice for aortic stenosis, management of mitral regurgitation, the selection of prosthetic valve type and antiplatelet/antithrombotic therapy for bioprostheses. The current review aims at providing a reasonable interpretation of the most important messages conveyed in the 2017 Focused Update and their implications for the future development of this area.

Citation： Zhengang ZHAO, Jilaihawi Hasan. 2017 ACC/AHA Focused Update of the Guideline for the Management of Patients with Valvular Heart Disease: key messages and future insights. West China Medical Journal, 2018, 33(2): 173-180. doi: 10.7507/1002-0179.201801144 Copy

1.	Nishimura RA, Otto CM, Bonow RO, et al. 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 practice guidelines. J Am Coll Cardiol, 2014, 129(23): E521-E643.
2.	Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 370(19): 1790-1798.
3.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in Intermediate-Risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
4.	Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med, 2016, 374(4): 344-353.
5.	Michler RE, Smith PK, Parides MK, et al. Two-Year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
6.	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. J Am Coll Cardiol, 2017, 70(2): 252-289.
7.	Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2485-2491.
8.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
9.	Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med, 2012, 366(18): 1696-1704.
10.	Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
11.	Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
12.	Deeb GM, Reardon MJ, Chetcuti S, et al. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(22): 2565-2574.
13.	Grover FL, Vemulapalli S, Carroll JD, et al. 2016 annual report of the society of thoracic surgeons/American college of cardiology transcatheter valve therapy registry. J Am Coll Cardiol, 2017, 69(10): 1215-1230.
14.	Walther T, Hamm CW, Schuler GA, et al. Perioperative results and complications in 15,964 transcatheter aortic valve replacements prospective data from the Gary registry. J Am Coll Cardiol, 2015, 65(20): 2173-2180.
15.	Gilard M, Schluter M, Snow TM, et al. The 2011-2012 pilot European Society of Cardiology Sentinel Registry of Transcatheter Aortic Valve Implantation: 12-month clinical outcomes. EuroIntervention, 2016, 12(1): 79-87.
16.	Auffret V, Lefevre T, Van Belle EA, et al. Temporal trends in transcatheter aortic valve replacement in France France 2 to France TAVI. J Am Coll Cardiol, 2017, 70(1): 42-55.
17.	Yoon SH, Ahn JM, Hayashida K, et al. Clinical outcomes following transcatheter aortic valve replacement in Asian population. JACC Cardiovasc Interv, 2016, 9(9): 926-933.
18.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
19.	Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
20.	Unzue L, Garcia E, Teijeiro R, et al. Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses. Cardiovasc Revasc Med, 2017. doi: 10.1016/j.carrev.2017.08.012.
21.	Frerker C, Bestehorn K, Schlueter MA, et al. In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany. Clin Res Cardiol, 2017, 106(8): 610-617.
22.	Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
23.	Thyregod HG, Steinbruchel DA, Nissen H, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis 1-Year results from the All-Comers NOTION randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
24.	Tribouilloy C, Rusinaru D, Grigioni FA, et al. Long-Term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets a multicenter analysis. Circ Cardiovasc Imaging, 2014, 7(2): 363-370.
25.	Suri RM, Vanoverschelde JL, Grigioni F, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA, 2013, 310(6): 609-616.
26.	Tribouilloy C, Rusinaru D, Szymanski CA, et al. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. Eur J Echocardiogr, 2011, 12(9): 702-710.
27.	Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?. Eur Heart J, 2007, 28(11): 1358-1365.
28.	Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation 5-year results of Everest II. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
29.	Chiang YP, Chikwe J, Moskowitz AJ, et al. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA, 2014, 312(13): 1323-1329.
30.	Chikwe J, Chiang YP, Egorova NN, et al. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA, 2015, 313(14): 1435-1442.
31.	Mcclure RS, Mcgurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1931-1939.
32.	Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA, 2014, 312(2): 162-170.
33.	Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves an 8-year single-center experience. JACC Cardiovasc Interv, 2015, 8(13): 1735-1744.
34.	Isaacs AJ, Shuhaiber J, Salemi A, et al. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. J Thorac Cardiovasc Surg, 2015, 149(5): 1262.
35.	Fujita B, Ensminger S, Bauer T, et al. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients. Eur J Cardiothorac Surg, 2017. doi: 10.1093/ejcts/ezx408.
36.	Gammie JS, Sheng S, Griffith BP, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2009, 87(5):1431-1437; discussion 1437-1439.
37.	Mérie C, Køber L, Skov Olsen P, et al. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA, 2012, 308(20): 2118-2125.
38.	Egbe AC, Pislaru SV, Pellikka PA, et al. Bioprosthetic valve thrombosis versus structural failure clinical and echocardiographic predictors. J Am Coll Cardiol, 2015, 66(21): 2285-2294.
39.	Dangas GD, Weitz JI, Giustino GA, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol, 2016, 68(24): 2671-2689.
40.	Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2015, 373(21): 2015-2024.
41.	Hansson NC, Grove EL, Andersen HR, et al. Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications. J Am Coll Cardiol, 2016, 68(19): 2059-2069.
42.	Pache G, Schoechlin S, Blanke P, et al. Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. Eur Heart J, 2016, 37(28): 2263-2271.
43.	Rodes-Cabau J, Masson JB, Welsh RC, et al. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (Aspirin versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) randomized clinical trial. JACC Cardiovasc Interv, 2017, 10(13): 1357-1365.

1. Nishimura RA, Otto CM, Bonow RO, et al. 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 practice guidelines. J Am Coll Cardiol, 2014, 129(23): E521-E643.
2. Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 370(19): 1790-1798.
3. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in Intermediate-Risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
4. Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med, 2016, 374(4): 344-353.
5. Michler RE, Smith PK, Parides MK, et al. Two-Year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
6. 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. J Am Coll Cardiol, 2017, 70(2): 252-289.
7. Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2485-2491.
8. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
9. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med, 2012, 366(18): 1696-1704.
10. Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
11. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
12. Deeb GM, Reardon MJ, Chetcuti S, et al. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(22): 2565-2574.
13. Grover FL, Vemulapalli S, Carroll JD, et al. 2016 annual report of the society of thoracic surgeons/American college of cardiology transcatheter valve therapy registry. J Am Coll Cardiol, 2017, 69(10): 1215-1230.
14. Walther T, Hamm CW, Schuler GA, et al. Perioperative results and complications in 15,964 transcatheter aortic valve replacements prospective data from the Gary registry. J Am Coll Cardiol, 2015, 65(20): 2173-2180.
15. Gilard M, Schluter M, Snow TM, et al. The 2011-2012 pilot European Society of Cardiology Sentinel Registry of Transcatheter Aortic Valve Implantation: 12-month clinical outcomes. EuroIntervention, 2016, 12(1): 79-87.
16. Auffret V, Lefevre T, Van Belle EA, et al. Temporal trends in transcatheter aortic valve replacement in France France 2 to France TAVI. J Am Coll Cardiol, 2017, 70(1): 42-55.
17. Yoon SH, Ahn JM, Hayashida K, et al. Clinical outcomes following transcatheter aortic valve replacement in Asian population. JACC Cardiovasc Interv, 2016, 9(9): 926-933.
18. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
19. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
20. Unzue L, Garcia E, Teijeiro R, et al. Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses. Cardiovasc Revasc Med, 2017. doi: 10.1016/j.carrev.2017.08.012.
21. Frerker C, Bestehorn K, Schlueter MA, et al. In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany. Clin Res Cardiol, 2017, 106(8): 610-617.
22. Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
23. Thyregod HG, Steinbruchel DA, Nissen H, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis 1-Year results from the All-Comers NOTION randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
24. Tribouilloy C, Rusinaru D, Grigioni FA, et al. Long-Term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets a multicenter analysis. Circ Cardiovasc Imaging, 2014, 7(2): 363-370.
25. Suri RM, Vanoverschelde JL, Grigioni F, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA, 2013, 310(6): 609-616.
26. Tribouilloy C, Rusinaru D, Szymanski CA, et al. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. Eur J Echocardiogr, 2011, 12(9): 702-710.
27. Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?. Eur Heart J, 2007, 28(11): 1358-1365.
28. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation 5-year results of Everest II. J Am Coll Cardiol, 2015, 66(25): 2844-2854.
29. Chiang YP, Chikwe J, Moskowitz AJ, et al. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA, 2014, 312(13): 1323-1329.
30. Chikwe J, Chiang YP, Egorova NN, et al. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA, 2015, 313(14): 1435-1442.
31. Mcclure RS, Mcgurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1931-1939.
32. Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA, 2014, 312(2): 162-170.
33. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves an 8-year single-center experience. JACC Cardiovasc Interv, 2015, 8(13): 1735-1744.
34. Isaacs AJ, Shuhaiber J, Salemi A, et al. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. J Thorac Cardiovasc Surg, 2015, 149(5): 1262.
35. Fujita B, Ensminger S, Bauer T, et al. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients. Eur J Cardiothorac Surg, 2017. doi: 10.1093/ejcts/ezx408.
36. Gammie JS, Sheng S, Griffith BP, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2009, 87(5):1431-1437; discussion 1437-1439.
37. Mérie C, Køber L, Skov Olsen P, et al. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA, 2012, 308(20): 2118-2125.
38. Egbe AC, Pislaru SV, Pellikka PA, et al. Bioprosthetic valve thrombosis versus structural failure clinical and echocardiographic predictors. J Am Coll Cardiol, 2015, 66(21): 2285-2294.
39. Dangas GD, Weitz JI, Giustino GA, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol, 2016, 68(24): 2671-2689.
40. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2015, 373(21): 2015-2024.
41. Hansson NC, Grove EL, Andersen HR, et al. Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications. J Am Coll Cardiol, 2016, 68(19): 2059-2069.
42. Pache G, Schoechlin S, Blanke P, et al. Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. Eur Heart J, 2016, 37(28): 2263-2271.
43. Rodes-Cabau J, Masson JB, Welsh RC, et al. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (Aspirin versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) randomized clinical trial. JACC Cardiovasc Interv, 2017, 10(13): 1357-1365.

West China Medical Journal

2017 ACC/AHA Focused Update of the Guideline for the Management of Patients with Valvular Heart Disease: key messages and future insights

Abstract Full text Figures/Tables Video References Cited by

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