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Valvular Heart Disease

Position papers and consensus documents from the Council on Valvular Heart Disease (former Working Group)

Valvular Heart Disease

Standards defining a ‘Heart Valve Centre’: ESC Working Group on Valvular Heart Disease and European Association for Cardiothoracic Surgery Viewpoint

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Authors: John B. Chambers, Bernard Prendergast, Bernard Iung, Raphael Rosenhek, Jose Luis Zamorano, Luc A. Piérard, Thomas Modine, Volkmar Falk, Arie Pieter Kappetein, Phillipe Pibarot, Thoralf Sundt, Helmut Baumgartner, Jeroen. J. Bax, Patrizio Lancellotti

Introduction: The increasing number of patients with heart valve disease and the wider range of therapeutic options now available, demands the standardisation of organisational structures.1,2 The ‘heart valve clinic’ is already established as a specialist outpatient clinic3,4 linked with multidisciplinary inpatient care as well as education and training. Recent international guidelines extend this specialist concept to a ‘Heart Valve Centre of Excellence’1 or ‘Heart Valve Centre’.2 These centres were proposed in order that durable mitral valve repair could be virtually guaranteed at close to zero risk in patients with asymptomatic severe mitral regurgitation caused by prolapse. The intention was that invasive valve interventions should not occur outside Heart Valve Centres. The standards defining such a centre have not previously been described and this is the purpose of this document. A Heart Valve Centre includes a heart valve clinic, but also multidisciplinary heart teams for the
care of patients with mitral valve disease, tricuspid valve disease, diseases of the aorta and aortic valve and infective endocarditis (Table 1).

Heart valve clinics: organisation, structure, and experiences

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Authors: Patrizio Lancellotti, Raphael Rosenhek, Philippe Pibarot, Bernard Iung, Catherine M. Otto, Pilar Tornos, Erwan Donal, Bernard Prendergast, Julien Magne, Giovanni La Canna, Luc A. Piérard, and Gerald Maurer

Aims: The aim of this position paper is to provide insights into the rationale, organisation, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organised structure and the delivery of standardised care protocols.

Conclusion: The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialised evaluation and care by dedicated physicians working in a specialised environment that are called the HVC. 

Assessing the risk of interventions in patients with valvular heart disease

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Authors:  Raphael Rosenhek (corresponding author), Bernard Iung, Pilar Tornos, Manuel J. Antunes, Bernard D. Prendergast, Catherine M. Otto, Arie Pieter Kappetein, Janina Stepinska, Jens J. Kaden, Christoph K. Naber, Esmeray Acartürk and Christa Gohlke-Bärwolf

First published online: March 15, 2011, Reference: Eur Heart J (2011) doi: 10.1093/eurheartj/ehr061

Aims: Risk scores provide an important contribution to clinical decision-making, but their validity has been questioned in patients with valvular heart disease (VHD) since current scores have been mainly derived and validated in adults undergoing coronary bypass surgery. The Working Group on Valvular Heart Disease of the European Society of Cardiology reviewed the performance of currently available scores when applied to VHD, in order to guide clinical practice and future development of new scores.

Methods and results: The most widely used risk scores (EuroSCORE, STS, and Ambler score) were reviewed, analysing variables included and their predictive ability when applied to patients with VHD. These scores provide relatively good discrimination, i.e. a gross estimation of risk category, but cannot be used to estimate the exact operative mortality in an individual patient because of unsatisfactory calibration.

Conclusion: Current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient with VHD. They should, therefore, be interpreted with caution and only used as part of an integrated approach, which incorporates other patient characteristics, the clinical context, and local outcome data. Future risk scores should include additional variables, such as cognitive and functional capacity and be prospectively validated in high-risk patients. Specific risk models should also be developed for newer interventions, such as transcatheter aortic valve implantation.

Recommendations on the management of the asymptomatic patient with valvular heart disease

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Authors:  B. Iung, C. Gohlke-Barwolf, P. Tornos, C. Tribouilloy, R. Hall,  E. Butchart and A. Vahanian

Published online: 2002 Reference: European Heart Journal (2002) 23, 1253–1266, doi:10.1053/euhj.2002.3320

Abstract: The management of asymptomatic patients with valve disease has become an important medical problem. There are two main reasons for this: firstly such patients are currently being diagnosed more frequently because of the widespread availability of echocardiography; secondly, the opportunity to perform less invasive interventions is an incentive to intervene earlier. However, data concerning the management of asymptomatic patients are limited. For this reason, this topic remains a particularly rich source of debate.