Aortic stenosis surgery indications: Difference between revisions

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{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]
==Overview==
Aortic stenosis requires [[aortic valve replacement]] if medical management does not successfully control symptoms.
According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.<ref>{{cite journal |author=Grube E, Laborde JC, Gerckens U, ''et al'' |title=Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study |journal=Circulation |volume=114 |issue=15 |pages=1616-24 |year=2006 |pmid=17015786 |doi=10.1161/CIRCULATIONAHA.106.639450}}</ref>


==Indications==
==Indications==


==ACC/AHA Guidelines- Indications for Surgery for Mitral Stenosis (DO NOT EDIT) <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>==
==ACC/AHA Guidelines- Indications for Surgery for Aortic Stenosis (DO NOT EDIT) <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>==
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{{cquote|
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===


'''1.''' MV surgery (repair if possible) is indicated in patients with symptomatic (NYHA functional class III–IV) moderate or severe MS* when 1) percutaneous mitral balloon valvotomy is unavailable, 2) percutaneous mitral balloon valvotomy is contraindicated because of left atrial thrombus despite anticoagulation or because concomitant moderate to severe MR is present, or 3) the valve morphology is not favorable for percutaneous mitral balloon valvotomy in a patient with acceptable operative risk. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
'''1.''' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])


'''2.''' Symptomatic patients with moderate to severe MS* who also have moderate to severe MR should receive MV replacement, unless valve repair is possible at the time of surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
'''2.''' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===


'''1.''' MV replacement is reasonable for patients with severe MS* and severe pulmonary hypertension (pulmonary artery systolic pressure greater than 60 mm Hg) with NYHA functional class I–II symptoms who are not considered candidates for percutaneous mitral balloon valvotomy or surgical MV repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
'''1.'''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===


'''1.''' MV repair may be considered for asymptomatic patients with moderate or severe MS* who have had recurrent embolic events while receiving adequate anticoagulation and who have valve morphology favorable for repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
'''1.''' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===


'''1.''' MV repair for MS is not indicated for patients with mild MS. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
'''1.'''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])


'''2.''' Closed commissurotomy should not be performed in patients undergoing MV repair; open commissurotomy is the preferred approach. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}}
'''2.''' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}}


==Sources==
==Sources==

Revision as of 16:36, 12 November 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]

Overview

Aortic stenosis requires aortic valve replacement if medical management does not successfully control symptoms. According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.[1]

Indications

ACC/AHA Guidelines- Indications for Surgery for Aortic Stenosis (DO NOT EDIT) [2]

Class I

1. (Level of Evidence: B)

2. (Level of Evidence: C)

Class IIa

1.(Level of Evidence: C)

Class IIb

1. (Level of Evidence: C)

Class III

1.(Level of Evidence: C)

2. (Level of Evidence: C)

Sources

  • 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [2].

References

  1. Grube E, Laborde JC, Gerckens U; et al. (2006). "Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study". Circulation. 114 (15): 1616–24. doi:10.1161/CIRCULATIONAHA.106.639450. PMID 17015786.
  2. 2.0 2.1 Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.

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