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| | ==Definition of Multivessel Disease== |
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| ==2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (VHD) <ref name="pmid28298458">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A |title=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 |journal=Circulation |volume=135 |issue=25 |pages=e1159–e1195 |year=2017 |pmid=28298458 |doi=10.1161/CIR.0000000000000503 |url=}}</ref><ref name="pmid28315732">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A |title=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 |journal=J. Am. Coll. Cardiol. |volume=70 |issue=2 |pages=252–289 |year=2017 |pmid=28315732 |doi=10.1016/j.jacc.2017.03.011 |url=}}</ref> ==
| | For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both: |
| | | * Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed) |
| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease <ref name="pmid28886619">{{cite journal |vauthors=Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL |title=2017 ESC/EACTS Guidelines for the management of valvular heart disease |journal=Eur. Heart J. |volume=38 |issue=36 |pages=2739–2791 |year=2017 |pmid=28886619 |doi=10.1093/eurheartj/ehx391 |url=}}</ref> ==
| | * Prior cardiac catheterization: 50% or greater stenosis of left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed) |
| | | * Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) <b><u>AND</u></b> prior PCI of at least 1 vessel different from index MI vessel |
| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease==
| | * Prior multivessel CABG |
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| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease==
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| ==2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (VHD)==
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| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease==
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| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease==
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| ===Indications for Antithrombotic Therapy for Mechanical Prosthesis===
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| ==='''{{Fontcolor|#FF0000|New Recommendations}}'''===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''Recommendations'''
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| ! style="width:8%" | ''' Class'''
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| ! style="width:80%" | '''Level'''
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| |-
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B || INR self-management is recommended provided appropriate training and quality control are performed.
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| | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C || The addition of low-dose aspirin (75-100 mg/day) to VKA may be considered in the case of concomitant atherosclerotic disease.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B || In patients treated with coronary stent implantation, triple therapy with aspirin (75-100 mg/day), clopidogrel (75 mg/day), and VKA should be considered for 1 month, irrespective of the type of stent used and the clinical presentation (i.e. ACS or stable CAD).
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B || Triple therapy comprising aspirin (75-100 mg/day), clopidogrel (75 mg/day), and VKA for longer than 1 month and up to 6 months should be considered in patients with high ischaemic risk due to ACS or other anatomical/procedural characteristics that outweigh the bleeding risk.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | A || Dual therapy comprising VKA and clopidogrel (75 mg/day) should be considered as an alternative to 1-month triple antithrombotic therapy in patients in whom the bleeding risk outweighs the ischaemic risk.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B || In patients who have undergone PCI, discontinuation of antiplatelet treatment should be considered at 12 months.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B || In patients requiring aspirin and/or clopidogrel in addition to VKA, the dose intensity of VKA should be carefully regulated with a target INR in the lower part of the recommended target range and a time in therapeutic range > 65-70%.
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| | bgcolor="LightCoral" | III || bgcolor="LightBlue" | B || The use of NOACs is contra-indicated.
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| |}
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| ===Indications for Antithrombotic Therapy for Bioprostheses===
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| ==='''{{Fontcolor|#FF0000|New Recommendations}}'''===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''Recommendations'''
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| ! style="width:8%" | ''' Class'''
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| ! style="width:80%" | '''Level'''
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| |-
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C || Dual antiplatelet therapy should be considered for the first 3-6 months after TAVI, followed by lifelong single antiplatelet therapy in patients who do not need oral anticoagulation for other reasons.
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| | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C || Single antiplatelet therapy may be considered after TAVI in the case of high bleeding risk.
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| |}
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| ==2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (VHD)==
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| ===Recommendations for Bridging Therapy for Prosthetic Valves===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C ||Continuation of Vitamin K antagonists (VKA) anticoagulation with a therapeutic INR is recommended in patients with mechanical heart valves undergoing minor procedures (such as dental extractions or cataract removal) where bleeding is easily controlled.|| 2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C || Temporary interruption of VKA anticoagulation, without bridging agents while the INR is subtherapeutic, is recommended in patients with a bileaflet mechanical AVR and no other risk factors for thrombosis who are undergoing invasive or surgical procedures. || 2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD ||Bridging anticoagulation therapy during the time interval when the INR is subtherapeutic preoperatively is reasonable on an individualized basis, with the risks of bleeding weighed against the benefits of thromboembolism prevention, for patients who are undergoing invasive or surgical procedures with a;
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| '''1)''' Mechanical AVR and any thromboembolic risk factor,
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| '''2)''' Older-generation mechanical AVR, or
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| '''3)''' Mechanical MVR.
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| | '''{{Fontcolor|#FF0000|MODIFIED:}}''' '''COR updated from I to IIa, LOE updated from C to C-LD.''' RCTs of bridging anticoagulant therapy versus no bridging therapy for patients with AF who do not have a mechanical heart valve have shown higher risk of bleeding without a change in incidence of thromboembolic events. This may have implications for bridging anticoagulation therapy for patients with prosthetic valves.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C || Administration of fresh frozen plasma or prothrombin complex concentrate is reasonable in patients with mechanical valves receiving VKA therapy who require emergency noncardiac surgery or invasive procedures || 2014 recommendation remains current.
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| |}
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| ===Recommendations for Mechanical Prosthetic Valve Thrombosis Diagnosis and Follow up===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR ||Urgent evaluation with multimodality imaging is indicated in patients with suspected mechanical prosthetic valve thrombosis to assess valvular function, leaflet motion, and the presence and extent of thrombus.|| '''{{Fontcolor|#FF0000|MODIFIED:}}''' '''LOE updated to B-NR.''' Multiple recommendations for imaging in patients with suspected mechanical prosthetic valve thrombosis were combined into a single recommendation. Multimodality imaging with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), fluoroscopy, and/or computed tomography (CT) scanning may be more effective than one imaging modality alone in detecting and characterizing valve thrombosis. Different imaging modalities are necessary because valve function, leaflet motion, and extent of thrombus should all be evaluated.
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| |}
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| ===Recommendations for Mechanical Prosthetic Valve Thrombosis Intervention===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || Urgent initial treatment with either slow-infusion low-dose fibrinolytic therapy or emergency surgery is recommended for patients with a thrombosed left-sided mechanical prosthetic heart valve presenting with symptoms of valve obstruction. ||'''{{Fontcolor|#FF0000|MODIFIED:}}''' '''LOE updated to B-NR.''' Multiple recommendations based only on NYHA class symptoms were combined into 1 recommendation. Slow-infusion fibrinolytic therapy has higher success rates and lower complication rates than prior high-dose regimens and is effective in patients previously thought to require urgent surgical intervention. The decision for emergency surgery versus fibrinolytic therapy should be based on multiple factors, including the availability of surgical expertise and the clinical experience with both treatments.
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| |}
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| ===Recommendations for Prosthetic Valve Stenosis===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C || Repeat valve replacement is indicated for severe symptomatic prosthetic valve stenosis. ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD ||In patients with suspected or confirmed bioprosthetic valve thrombosis who are hemodynamically stable and have no contraindications to anticoagulation, initial treatment with a VKA is reasonable. ||'''{{Fontcolor|#FF0000|NEW:}}''' Case series of patients presenting with bioprosthetic valve stenosis have suggested improvement in hemodynamics with VKA treatment because of resolution of thrombus on the valve leaflets.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-NR ||For severely symptomatic patients with bioprosthetic aortic valve stenosis judged by the heart team to be at high or prohibitive risk of reoperation, and in whom improvement in hemodynamics is anticipated, a transcatheter valve-in-valve procedure is reasonable. ||'''{{Fontcolor|#FF0000|NEW:}}''' Registries and case series have reported on the short-term outcomes and complication rates in patients with bioprosthetic AS who have undergone transcatheter valve-in-valve therapy.
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| |}
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| ===Recommendations for Prosthetic Valve Regurgitation===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| |-
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B || Surgery is recommended for operable patients with mechanical heart valves with intractable hemolysis or HF due to severe prosthetic or paraprosthetic regurgitation. ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD ||Surgery is reasonable for asymptomatic patients with severe bioprosthetic regurgitation if operative risk is acceptable. ||'''{{Fontcolor|#FF0000|MODIFIED:}}''' '''LOE updated from C to C-LD.''' A specific indication for surgery is the presence of severe bioprosthetic regurgitation in a patient with acceptable operative risk. With the new recommendation for valve-in-valve therapy, indications for intervention need to account for patients who would benefit from surgery versus those who would benefit from transcatheter therapy, determined by type of valve, symptomatic status, and risk of reoperation.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD || Surgery is reasonable for asymptomatic patients with severe bioprosthetic regurgitation if operative risk is acceptable. ||'''{{Fontcolor|#FF0000|MODIFIED:}}''' '''LOE updated from C to C-LD.''' A specific indication for surgery is the presence of severe bioprosthetic regurgitation in a patient with acceptable operative risk. With the new recommendation for valve-in-valve therapy, indications for intervention need to account for patients who would benefit from surgery versus those who would benefit from transcatheter therapy, determined by type of valve, symptomatic status, and risk of reoperation.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B || Percutaneous repair of paravalvular regurgitation is reasonable in patients with prosthetic heart valves and intractable hemolysis or NYHA class III/IV HF who are at high risk for surgery and have anatomic features suitable for catheter-based therapy when performed in centers with expertise in the procedure || 2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-NR || For severely symptomatic patients with bioprosthetic aortic valve regurgitation judged by the heart team to be at high or prohibitive risk for surgical therapy, in whom improvement in hemodynamics is anticipated, a transcatheter valve-in-valve procedure is reasonable. || '''{{Fontcolor|#FF0000|NEW:}}''' Registries and case series of patients have reported on the short-term outcomes and complication rates for patients with bioprosthetic aortic regurgitation who have undergone transcatheter valve-in-valve replacement.
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| |}
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| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease==
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| ===Management of Prosthetic Valve Dysfunction===
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| ==='''{{Fontcolor|#FF0000|New Recommendations}}'''===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''Recommendations'''
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| ! style="width:8%" | ''' Class'''
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| ! style="width:80%" | '''Level'''
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| |-
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C || Anticoagulation using a VKA and/or UFH is recommended in bioprosthetic valve thrombosis before considering reintervention.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-NR || Transcatheter closure may be considered for paravalvular leaks with clinically significant regurgitation in surgical high- risk patients (Heart Team decision).
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C || Transcatheter valve-in-valve implantation in aortic position should be considered by the Heart Team depending on the risk of reoperation and the type and size of prosthesis.
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| |}
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| ==2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (VHD)==
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| ===Recommendations for Infective Endocarditis Intervention===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
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| ! style="width:12%" | '''COR'''
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| ! style="width:8%" | ''' LOE'''
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| ! style="width:40%" | '''RECOMMENDATION'''
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| ! style="width:40%" | '''COMMENT/RATIONALE'''
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B || Decisions about timing of surgical intervention should be made by a multispecialty Heart Valve Team of cardiology, cardiothoracic surgery, and infectious disease specialists. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with IE who present with valve dysfunction resulting in symptoms of HF. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with left-sided IE caused by S. aureus, fungal, or other highly resistant organisms. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with IE complicated by heart block, annular or aortic abscess, or destructive penetrating lesions. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) for IE is indicated in patients with evidence of persistent infection as manifested by persistent bacteremia or fevers lasting longer than 5 to 7 days after onset of appropriate antimicrobial therapy. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C ||Surgery is recommended for patients with prosthetic valve endocarditis and relapsing infection (defined as recurrence of bacteremia after a complete course of appropriate antibiotics and subsequently negative blood cultures) without other identifiable source for portal of infection. ||2014 recommendation remains current.
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| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B ||Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is indicated as
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| part of the early management plan in patients with IE with documented infection of the device or leads.
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| |2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B ||Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is reasonable in patients with valvular IE caused by S. aureus or fungi, even without evidence of device or lead infection. ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C ||Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is reasonable in patients undergoing valve surgery for valvular IE. ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is reasonable in patients with IE who present with recurrent emboli and persistent vegetations despite appropriate antibiotic therapy. ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | B ||Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) may be considered in patients with native valve endocarditis who exhibit mobile vegetations greater than 10 mm in length (with or without clinical evidence of embolic phenomenon). ||2014 recommendation remains current.
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| | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | B-NR ||Operation without delay may be considered in patients with IE and an indication for surgery who have suffered a stroke but have no evidence of intracranial hemorrhage or extensive neurological damage. ||'''{{Fontcolor|#FF0000|NEW:}}''' The risk of postoperative neurological deterioration is low after a cerebral event that has not resulted in extensive neurological damage or intracranial hemorrhage. If surgery is required after a neurological event, recent data favor early surgery for better overall outcomes.
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| | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | B-NR ||Delaying valve surgery for at least 4 weeks may be considered for patients with IE and major ischemic stroke or intracranial hemorrhage if the patient is hemodynamically stable. ||'''{{Fontcolor|#FF0000|NEW:}}''' In patients with extensive neurological damage or intracranial hemorrhage, cardiac surgery carries a high risk of death if performed within 4 weeks of a hemorrhagic stroke.
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| |}
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| ==2017 ESC/EACTS Guidelines for the management of valvular heart disease <ref name="pmid28886619">{{cite journal |vauthors=Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL |title=2017 ESC/EACTS Guidelines for the management of valvular heart disease |journal=Eur. Heart J. |volume=38 |issue=36 |pages=2739–2791 |year=2017 |pmid=28886619 |doi=10.1093/eurheartj/ehx391 |url=}}</ref> ==
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| ===Management of Coronary Artery Disease (CAD) in patients with Valvular Heart Disease (VHD)===
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| {| class="wikitable" style="width: 80%; text-align: justify;"
| | Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size. |
| ! style="width:80%" | '''Recommendations'''
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| ! style="width:10%" | ''' Class'''
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| ! style="width:10%" | '''Level'''
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| | colspan="3" |'''Diagnosis of Coronary Artery Disease'''
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| | Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following:
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| • history of cardiovascular disease
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| • suspected myocardial ischaemiad
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|
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| • LV systolic dysfunction • in men >40 years of age and postmenopausal women
| | ==MVD Tool== |
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| • one or more cardiovascular risk factors.
| | {| |
| | bgcolor="LightGreen" | I || bgcolor="LightBlue" | C
| | {{#Widget:MVD5}} |
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| | Coronary angiography is recommended in the evaluation of moderate to severe secondary mitral regurgitation. || bgcolor="LightGreen" | I || bgcolor="LightBlue" | C
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| | CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. || bgcolor="LightGreen" | II || bgcolor="LightBlue" | A
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| | CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. || bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C
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| | colspan="3" | '''Indications for Myocardial Revascularization'''
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| | CABG is recommended in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥70% || bgcolor="LightGreen" | I || bgcolor="LightBlue" | C
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| | CABG should be considered in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥50–70%.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C
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| |-
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| | PCI should be considered in patients with a primary indication to undergo TAVI and coronary artery diameter stenosis >70% in proximal segments.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C
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| |-
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| | PCI should be considered in patients with a primary indication to undergo transcatheter mitral valve interventions and coronary artery diameter stenosis >70% in proximal segments.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C
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| | colspan="3" |CABG = coronary artery bypass grafting; CAD = coronary artery disease; CT = computed tomography; LV = left ventricular; MSCT = multislice computed tomography; PCI = percutaneous coronary intervention; TAVI = transcatheter aortic valve implantation; VHD = valvular heart disease.
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| |} | | |} |
| <references />
| |