ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis

  • Grace Lee
    Temerty Faculty of Medicine, 1 King's College Circle , Toronto, ON M5S1A8 , Canada
  • Joanna Chikwe
    Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center , 127 San Vicente Blvd a3600, Los Angeles, CA 90048 , USA
  • Milan Milojevic
    Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute , Heroja Milana Tepića 1, Belgrade , Serbia
  • Harindra C Wijeysundera
    Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, M4N 3M5, University of Toronto , Toronto, ON , Canada
  • Giuseppe Biondi-Zoccai
    Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome , Piazzale Aldo Moro, 5, 00185 Roma RM , Italy
  • Marcus Flather
    Norwich Medical School, University of East Anglia , Norwich Research Park, Norwich NR4 7TJ , UK
  • Mario F L Gaudino
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 1300 York Ave, NY New York , USA
  • Stephen E Fremes
    Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, ON , Canada
  • Derrick Y Tam
    Division of Cardiac Surgery, University of Toronto , 200 Elizabeth St., Toronto, ON M5G 2C4 , Canada

抄録

<jats:title>Abstract</jats:title><jats:p>Aortic stenosis (AS) is a serious and complex condition, for which optimal management continues to evolve rapidly. An understanding of current clinical practice guidelines is critical to effective patient care and shared decision-making. This state of the art review of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines and 2020 American College of Cardiology/American Heart Association Guidelines compares their recommendations for AS based on the evidence to date. The European and American guidelines were generally congruent with the exception of three key distinctions. First, the European guidelines recommend intervening at a left ventricular ejection fraction of 55%, compared with 60% over serial imaging by the American guidelines for asymptomatic patients. Second, the European guidelines recommend a threshold of ≥65 years for surgical bioprosthesis, whereas the American guidelines employ multiple age categories, providing latitude for patient factors and preferences. Third, the guidelines endorse different age cut-offs for transcatheter vs. surgical aortic valve replacement, despite limited evidence. This review also discusses trends indicating a decreasing proportion of mechanical valve replacements. Finally, the review identifies gaps in the literature for areas including transcatheter aortic valve implantation in asymptomatic patients, the appropriateness of Ross procedures, concomitant coronary revascularization with aortic valve replacement, and bicuspid AS. To summarize, this state of the art review compares the latest European and American guidelines on the management of AS to highlight three areas of divergence: timing of intervention, valve selection, and surgical vs. transcatheter aortic valve replacement criteria.</jats:p>

収録刊行物

被引用文献 (1)*注記

もっと見る

詳細情報 詳細情報について

問題の指摘

ページトップへ