From the Guidelines
The best treatment option for symptomatic patients with valvular heart disease is typically valve repair or replacement surgery, with the specific approach depending on the affected valve, disease severity, and patient factors, as recommended by the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1.
Key Considerations
- For patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are recommended, with the choice of intervention depending on symptoms, ventricular function, and surgical risk 1.
- For mitral regurgitation, mitral valve repair is preferred when feasible, while mitral valve replacement may be necessary in cases where repair isn't possible, with consideration of the patient's symptoms and left ventricular function 1.
- Before surgery, medical management includes diuretics, beta-blockers or calcium channel blockers, and ACE inhibitors to manage symptoms and reduce disease progression, as well as anticoagulation with warfarin for mechanical valves 1.
Treatment Approach
- The treatment approach should be individualized based on the patient's specific condition, with consideration of the disease stage, valve anatomy, and ventricular function, as well as the patient's symptoms and quality of life 1.
- Regular echocardiographic monitoring is essential to determine the optimal timing for intervention and to assess disease progression, with the goal of improving symptoms, reducing morbidity, and improving quality of life 1.
Recent Guidelines
- The 2021 ACC/AHA guideline for the management of patients with valvular heart disease provides a comprehensive framework for the evaluation and treatment of patients with valvular heart disease, including recommendations for valve repair and replacement surgery, as well as medical management and anticoagulation therapy 1.
- The guideline emphasizes the importance of a multidisciplinary team approach to patient care, with consideration of the patient's individual needs and preferences, as well as the latest evidence-based treatments and technologies 1.
From the Research
Treatment Options for Symptomatic Valvular Heart Disease
The best treatment option for patients with valvular heart disease who are symptomatic depends on various factors, including the type and severity of the valve disease, the patient's overall health, and the presence of any comorbidities.
- For patients with aortic stenosis, valve replacement is recommended for those with symptoms such as syncope, presyncope, heart failure, angina, or severe aortic stenosis with left ventricular dysfunction 2.
- For patients with chronic aortic regurgitation, open surgical replacement is recommended if they are symptomatic or asymptomatic but have severe regurgitation and left ventricular dysfunction 2.
- For patients with mitral stenosis, treatment involves drugs for heart rate control and anticoagulation if they have atrial fibrillation, and invasive treatment involves valve replacement or percutaneous commissurotomy 2.
- For patients with severe chronic mitral regurgitation, management consists of valve replacement or a percutaneous transcatheter procedure that clips the mitral leaflets together 2, 3.
- Transcatheter valve therapies, such as transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair, have emerged as important therapeutic options for patients who are candidates for heart valve replacement 3.
Role of Multidisciplinary Heart Teams
Multidisciplinary heart teams play a crucial role in determining the optimal approach for managing patients with valvular heart disease.
- These teams consist of interventional cardiologists, cardiothoracic surgeons, radiologists, echocardiographers, nurses, and social workers 4, 3.
- The heart team works together to determine the best treatment strategy for each patient, taking into account individual anatomy, comorbidities, and patient preference 3.
Importance of Imaging and Diagnostic Testing
Imaging and diagnostic testing are essential for determining the severity and type of valvular heart disease.
- Echocardiography is the principal examination for determining severity, mechanism, and hemodynamic consequences of mitral regurgitation 5.
- Multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, computed tomography, and intracardiac echocardiography, is important for preprocedural planning, device selection, and optimal outcomes 3.