Dr. Gonzalo Baron Esquivias,
The most important and/or novel aspects of the guidelines were:
1. The importance of consensus decision-making and the establishment of the “heart team” as the cornerstone of diagnosis, prognostic evaluation, and decision-making on treatment
The ‘heart team’ should have a particular expertise in valvular heart disease (VHD), including cardiologists, cardiac surgeons, imaging specialists, anaesthetists and, if needed, general practitioners, geriatricians, or intensive care specialists. This ‘heart team’ approach is particularly advisable in the management of high-risk patients and is also important for other subsets, such as asymptomatic patients, where the evaluation of valve reparability is a key component in decision-making.
2. Clinical evaluationThe patient should be questioned on his/her lifestyle to detect progressive changes in daily activity in order to limit the subjectivity of symptom analysis, particularly in the elderly. Clinical examination plays a major role in the detection of VHD in asymptomatic patients. It is the first step in the definitive diagnosis of VHD and the assessment of its severity. An electrocardiogram (ECG) and a chest X-ray are usually carried out in conjunction with a clinical examination. Intervention is indicated in patients with severe valve disease causing symptoms and /or ventricular dysfunction unless the ‘heart team’ states that the patient is not suitable for surgery.Essential questions in the evaluation of a patient for valvular intervention:
3. Confirmation of echocardiography as the key tool in diagnosing and quantifying the severity of valvular heart disease, and for prognostic evaluation The wider use of echocardiography due to new technologies and its use in different situations are also noted. Echocardiography is recognized as the patient assessment technique par excellence. However, the guidelines emphasize that decisions should not be based on any one parameter or threshold, but rather on an integrated approach to assessing the severity of lesions.
4. Developments in aortic stenosis (AS), which included a recognition that low-gradient, low-flow aortic stenosis (AS) with preserved ejection fraction constituted a new problem for clinical diagnosis, and modifications to surgical indications for asymptomatic AS:
5. Changes in previous recommendations regarding aortic surgery, and assumption that in aortic regurgitation pathology of the aortic root is frequent
6. Developments in surgical indications for mitral regurgitation (MR)
7. Few changes in mitral stenosis
8. Changes in surgical indications for tricuspid regurgitation
9. Indications and choice on prosthesis types
The choice of the type of valve prosthesis should be individualized and discussed in detail with the patient and surgeon, taking into account multiple factors, but age is the crucial factor.
10. Indications on antithrombotic therapy for patients with prosthetic valves
11. The incorporation of percutaneous techniques for selected cases of severe AS and MR
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