Skip main navigation

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Originally publishedhttps://doi.org/10.1161/CIR.0000000000000503Circulation. 2017;135:e1159–e1195

Table of Contents

Preamblee 1160

1. Introduction e1161

1.1. Methodology and Evidence Review e1162

1.2. Organization of the Writing Group e1162

1.3. Document Review and Approval e1163

2. General Principles e1163

2.4. Basic Principles of Medical Therapy e1163

2.4.2. Infective Endocarditis Prophylaxis: Recommendation e1163

2.4.3. Anticoagulation for Atrial Fibrillation in Patients With VHD: Recommendations (New Section) e1164

3. Aortic Stenosis e1164

3.2. Aortic Stenosis e1164

3.2.4. Choice of Intervention: Recommendations e1164

7. Mitral Regurgitation e1167

7.2. Stages of Chronic MR e1167

7.3. Chronic Primary MR e1168

7.3.3. Intervention: Recommendations e1168

7.4. Chronic Secondary MR e1170

7.4.3. Intervention: Recommendations e1170

11. Prosthetic Valves e1171

11.1. Evaluation and Selection of Prosthetic Valves e1171

11.1.2. Intervention: Recommendations e1171

11.2. Antithrombotic Therapy for Prosthetic Valves e1172

11.2.1. Diagnosis and Follow-Up e1172

11.2.2. Medical Therapy: Recommendations e1173

11.3. Bridging Therapy for Prosthetic Valves e1174

11.3.1. Diagnosis and Follow-Up e1174

11.3.2. Medical Therapy: Recommendations e1174

11.6. Acute Mechanical Prosthetic Valve Thrombosis e1175

11.6.1. Diagnosis and Follow-Up: Recommendation e1175

11.6.3. Intervention: Recommendation e1176

11.7. Prosthetic Valve Stenosis e1176

11.7.3. Intervention: Recommendation e1177

11.8. Prosthetic Valve Regurgitation e1178

11.8.3. Intervention: Recommendations e1178

12. Infective Endocarditis e1179

12.2. Infective Endocarditis e1179

12.2.3. Intervention: Recommendations e1179

Referencese 1181

Appendix 1. Author Relationships With Industry and Other Entities (Relevant) e1189

Appendix 2. Reviewer Relationships With Industry and Other Entities (Comprehensive) e1191

Appendix 3. Abbreviations e1195

Preamble

Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality cardiovascular care. The ACC and AHA sponsor the development and publication of guidelines without commercial support, and members of each organization volunteer their time to the writing and review efforts. Guidelines are official policy of the ACC and AHA.

Intended Use

Practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease. The focus is on medical practice in the United States, but guidelines developed in collaboration with other organizations may have a global impact. Although guidelines may be used to inform regulatory or payer decisions, their intent is to improve patients’ quality of care and align with patients’ interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment.

Clinical Implementation

Guideline recommended management is effective only when followed by healthcare providers and patients. Adherence to recommendations can be enhanced by shared decision making between healthcare providers and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities.

Methodology and Modernization

The ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) continuously reviews, updates, and modifies guideline methodology on the basis of published standards from organizations including the Institute of Medicine1,2 and on the basis of internal reevaluation. Similarly, the presentation and delivery of guidelines are reevaluated and modified on the basis of evolving technologies and other factors to facilitate optimal dissemination of information at the point of care to healthcare professionals. Given time constraints of busy healthcare providers and the need to limit text, the current guideline format delineates that each recommendation be supported by limited text (ideally, <250 words) and hyperlinks to supportive evidence summary tables. Ongoing efforts to further limit text are underway. Recognizing the importance of cost–value considerations in certain guidelines, when appropriate and feasible, an analysis of the value of a drug, device, or intervention may be performed in accordance with the ACC/AHA methodology.3

To ensure that guideline recommendations remain current, new data are reviewed on an ongoing basis, with full guideline revisions commissioned in approximately 6-year cycles. Publication of new, potentially practice-changing study results that are relevant to an existing or new drug, device, or management strategy will prompt evaluation by the Task Force, in consultation with the relevant guideline writing committee, to determine whether a focused update should be commissioned. For additional information and policies regarding guideline development, we encourage readers to consult the ACC/AHA guideline methodology manual4 and other methodology articles.58

Selection of Writing Committee Members

The Task Force strives to avoid bias by selecting experts from a broad array of backgrounds. Writing committee members represent different geographic regions, sexes, ethnicities, races, intellectual perspectives/biases, and scopes of clinical practice. The Task Force may also invite organizations and professional societies with related interests and expertise to participate as partners, collaborators, or endorsers.

Relationships With Industry and Other Entities

The ACC and AHA have rigorous policies and methods to ensure that guidelines are developed without bias or improper influence. The complete relationships with industry and other entities (RWI) policy can be found online. Appendix 1 of the current document lists writing committee members’ relevant RWI. For the purposes of full transparency, writing committee members’ comprehensive disclosure information is available online, as is comprehensive disclosure information for the Task Force.

Evidence Review and Evidence Review Committees

When developing recommendations, the writing committee uses evidence-based methodologies that are based on all available data.47 Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only key references are cited.

An independent evidence review committee (ERC) is commissioned when there are 1 or more questions deemed of utmost clinical importance that merit formal systematic review. This systematic review will strive to determine which patients are most likely to benefit from a drug, device, or treatment strategy and to what degree. Criteria for commissioning an ERC and formal systematic review include: a) the absence of a current authoritative systematic review, b) the feasibility of defining the benefit and risk in a time frame consistent with the writing of a guideline, c) the relevance to a substantial number of patients, and d) the likelihood that the findings can be translated into actionable recommendations. ERC members may include methodologists, epidemiologists, healthcare providers, and biostatisticians. When a formal systematic review has been commissioned, the recommendations developed by the writing committee on the basis of the systematic review are marked with sr.

Guideline-Directed Management and Therapy

The term guideline-directed management and therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and pharmacological and procedural treatments. For these and all recommended drug treatment regimens, the reader should confirm the dosage by reviewing product insert material and evaluate the treatment regimen for contraindications and interactions. The recommendations are limited to drugs, devices, and treatments approved for clinical use in the United States.

Class of Recommendation and Level of Evidence

The Class of Recommendation (COR) indicates the strength of the recommendation, encompassing the estimated magnitude and certainty of benefit in proportion to risk. The Level of Evidence (LOE) rates the quality of scientific evidence that supports the intervention on the basis of the type, quantity, and consistency of data from clinical trials and other sources (Table 1).46

Table 1. ACC/AHA Recommendation System: Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015)

Table 1.

Glenn N. Levine, MD, FACC, FAHA

Chair, ACC/AHA Task Force on Clinical Practice Guidelines

1. Introduction

The focus of the “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease”9,10 (2014 VHD guideline) was the diagnosis and management of adult patients with valvular heart disease (VHD). The field of VHD is rapidly progressing, with new knowledge of the natural history of patients with valve disease, advances in diagnostic imaging, and improvements in catheter-based and surgical interventions. Several randomized controlled trials (RCTs) have been published since the 2014 VHD guideline, particularly with regard to the outcomes of interventions. Major areas of change include indications for transcatheter aortic valve replacement (TAVR), surgical management of the patient with primary and secondary mitral regurgitation (MR), and management of patients with valve prostheses.

All recommendations (new, modified, and unchanged) for each clinical section are included to provide a comprehensive assessment. The text explains new and modified recommendations, whereas recommendations from the previous guideline that have been deleted or superseded no longer appear. Please consult the full-text version of the 2014 VHD guideline10 for text and evidence tables supporting the unchanged recommendations and for clinical areas not addressed in this focused update. Individual recommendations in this focused update will be incorporated into the full-text guideline in the future. Recommendations from the prior guideline that remain current have been included for completeness but the LOE reflects the COR/LOE system used when initially developed. New and modified recommendations in this focused update reflect the latest COR/LOE system, in which LOE B and C are subcategorized for greater specificity.47 The section numbers correspond to the full-text guideline sections.

1.1. Methodology and Evidence Review

To identify key data that might influence guideline recommendations, the Task Force and members of the 2014 VHD guideline writing committee reviewed clinical trials that were presented at the annual scientific meetings of the ACC, AHA, European Society of Cardiology, and other groups and that were published in peer-reviewed format from October 2013 through November 2016. The evidence is summarized in tables in the Online Data Supplement.

1.2. Organization of the Writing Group

For this focused update, representative members of the 2014 VHD writing committee were invited to participate, and they were joined by additional invited members to form a new writing group, referred to as the 2017 focused update writing group. Members were required to disclose all RWI relevant to the data under consideration. The group was composed of experts representing cardiovascular medicine, cardiovascular imaging, interventional cardiology, electrophysiology, cardiac surgery, and cardiac anesthesiology. The writing group included representatives from the ACC, AHA, American Association for Thoracic Surgery (AATS), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Cardiovascular Anesthesiologists (SCA), and Society of Thoracic Surgeons (STS).

1.3. Document Review and Approval

The focused update was reviewed by 2 official reviewers each nominated by the ACC and AHA; 1 reviewer each from the AATS, ASE, SCAI, SCA, and STS; and 40 content reviewers. Reviewers’ RWI information is published in this document (Appendix 2).

This document was approved for publication by the governing bodies of the ACC and the AHA and was endorsed by the AATS, ASE, SCAI, SCA, and STS.

2. General Principles

2.4. Basic Principles of Medical Therapy

2.4.2. Infective Endocarditis Prophylaxis: Recommendation

With the absence of RCTs that demonstrated the efficacy of antibiotic prophylaxis to prevent infective endocarditis (IE), the practice of antibiotic prophylaxis has been questioned by national and international medical societies.1114 Moreover, there is not universal agreement on which patient populations are at higher risk of developing IE than the general population. Protection from endocarditis in patients undergoing high-risk procedures is not guaranteed. A prospective study demonstrated that prophylaxis given to patients for what is typically considered a high-risk dental procedure reduced but did not eliminate the incidence of bacteremia.15 A 2013 Cochrane Database systematic review of antibiotic prophylaxis of IE in dentistry concluded that there is no evidence to determine whether antibiotic prophylaxis is effective or ineffective, highlighting the need for further study of this longstanding clinical dilemma.13 Epidemiological data conflict with regard to incidence of IE after adoption of more limited prophylaxis, as recommended by the AHA and European Society of Cardiology,1620 and no prophylaxis, as recommended by the U.K. NICE (National Institute for Health and Clinical Excellence) guidelines.21 Some studies indicate no increase in incidence of endocarditis with limited or no prophylaxis, whereas others suggest that IE cases have increased with adoption of the new guidelines.1622 The consensus of the writing group is that antibiotic prophylaxis is reasonable for the subset of patients at increased risk of developing IE and at high risk of experiencing adverse outcomes from IE. There is no evidence for IE prophylaxis in gastrointestinal procedures or genitourinary procedures, absent known active infection.

Recommendation for IE Prophylaxis

2.4.3. Anticoagulation for Atrial Fibrillation in Patients With VHD: Recommendations (New Section)

Recommendations for Anticoagulation for Atrial Fibrillation (AF) in Patients With VHD

3. Aortic Stenosis

3.2. Aortic Stenosis

3.2.4. Choice of Intervention: Recommendations

The recommendations for choice of intervention for AS apply to both surgical AVR and TAVR; indications for AVR are discussed in Section 3.2.3 in the 2014 VHD guideline. The integrative approach to assessing risk of surgical AVR or TAVR is discussed in Section 2.5 in the 2014 VHD guideline. The choice of proceeding with surgical AVR versus TAVR is based on multiple factors, including the surgical risk, patient frailty, comorbid conditions, and patient preferences and values.41 Concomitant severe coronary artery disease may also affect the optimal intervention because severe multivessel coronary disease may best be served by surgical AVR and coronary artery bypass graft surgery (CABG). See Figure 1 for an algorithm on choice of TAVR versus surgical AVR.

Figure 1.

Figure 1. Choice of TAVR Versus Surgical AVR in the Patient With Severe Symptomatic AS.

AS indicates aortic stenosis; AVR, aortic valve replacement; and TAVR, transcatheter aortic valve replacement.

Recommendations for Choice of Intervention

7. Mitral Regurgitation

7.2. Stages of Chronic MR

In chronic secondary MR, the mitral valve leaflets and chords usually are normal (Table 2 in this focused update; Table 16 from the 2014 VHD guideline). Instead, MR is associated with severe LV dysfunction due to coronary artery disease (ischemic chronic secondary MR) or idiopathic myocardial disease (nonischemic chronic secondary MR). The abnormal and dilated left ventricle causes papillary muscle displacement, which in turn results in leaflet tethering with associated annular dilation that prevents adequate leaflet coaptation. There are instances in which both primary and secondary MR are present. The best therapy for chronic secondary MR is not clear because MR is only 1 component of the disease, with clinical outcomes also related to severe LV systolic dysfunction, coronary disease, idiopathic myocardial disease, or other diseases affecting the heart muscle. Thus, restoration of mitral valve competence is not curative. The optimal criteria for defining severe secondary MR have been controversial. In patients with secondary MR, some data suggest that, compared with primary MR, adverse outcomes are associated with a smaller calculated effective regurgitant orifice, possibly because of the fact that a smaller regurgitant volume may still represent a large regurgitant fraction in the presence of compromised LV systolic function (and low total stroke volume) added to the effects of elevated filling pressures. In addition, severity of secondary MR may increase over time because of the associated progressive LV systolic dysfunction and dysfunction due to adverse remodeling of the left ventricle. Finally, Doppler methods for calculations of effective regurgitant orifice area by the flow convergence method may underestimate severity because of the crescentic shape of the regurgitant orifice, and multiple parameters must be used to determine the severity of MR.67,68 Even so, on the basis of the criteria used for determination of “severe” MR in RCTs of surgical intervention for secondary MR,6972 the recommended definition of severe secondary MR is now the same as for primary MR (effective regurgitant orifice ≥0.4 cm2 and regurgitant volume ≥60 mL), with the understanding that effective regurgitant orifice cutoff of >0.2 cm2 is more sensitive and >0.4 cm2 is more specific for severe MR. However, it is important to integrate the clinical and echocardiographic findings together to prevent unnecessary operation when the MR may not be as severe as documented on noninvasive studies.

Table 2. Stages of Secondary MR (Table 16 in the 2014 VHD Guideline)

GradeDefinitionValve AnatomyValve Hemodynamics*Associated Cardiac FindingsSymptoms
AAt risk of MRNormal valve leaflets, chords, and annulus in a patient with coronary disease or cardiomyopathyNo MR jet or small central jet area <20% LA on DopplerSmall vena contracta <0.30 cmNormal or mildly dilated LV size with fixed (infarction) or inducible (ischemia) regional wall motion abnormalitiesPrimary myocardial disease with LV dilation and systolic dysfunctionSymptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy
BProgressive MRRegional wall motion abnormalities with mild tethering of mitral leafletAnnular dilation with mild loss of central coaptation of the mitral leafletsERO <0.40 cm2Regurgitant volume <60 mLRegurgitant fraction <50%Regional wall motion abnormalities with reduced LV systolic functionLV dilation and systolic dysfunction due to primary myocardial diseaseSymptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy
CAsymptomatic severe MRRegional wall motion abnormalities and/or LV dilation with severe tethering of mitral leafletAnnular dilation with severe loss of central coaptation of the mitral leafletsERO ≥0.40 cm2Regurgitant volume ≥60 mLRegurgitant fraction <50%Regional wall motion abnormalities with reduced LV systolic functionLV dilation and systolic dysfunction due to primary myocardial diseaseSymptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy
DSymptomatic severe MRRegional wall motion abnormalities and/or LV dilation with severe tethering of mitral leafletAnnular dilation with severe loss of central coaptation of the mitral leafletsERO ≥0.40 cm2Regurgitant volume ≥60 mLRegurgitant fraction ≥50%Regional wall motion abnormalities with reduced LV systolic functionLV dilation and systolic dysfunction due to primary myocardial diseaseHF symptoms due to MR persist even after revascularization and optimization of medical therapyDecreased exercise toleranceExertional dyspnea

*Several valve hemodynamic criteria are provided for assessment of MR severity, but not all criteria for each category will be present in each patient. Categorization of MR severity as mild, moderate, or severe depends on data quality and integration of these parameters in conjunction with other clinical evidence.

The measurement of the proximal isovelocity surface area by 2D TTE in patients with secondary MR underestimates the true ERO because of the crescentic shape of the proximal convergence.

2D indicates 2-dimensional; ERO, effective regurgitant orifice; HF, heart failure; LA, left atrium; LV, left ventricular; MR, mitral regurgitation; and TTE, transthoracic echocardiogram.

7.3. Chronic Primary MR

7.3.3. Intervention: Recommendations

Recommendations for Chronic Primary MR Intervention

7.4. Chronic Secondary MR

7.4.3. Intervention: Recommendations

Chronic severe secondary MR adds volume overload to a decompensated LV and worsens prognosis. However, there are only sparse data to indicate that correcting MR prolongs life or even improves symptoms over an extended time. Percutaneous mitral valve repair provides a less invasive alternative to surgery but is not approved for clinical use for this indication in the United States.70,72,125127 The results of RCTs examining the efficacy of percutaneous mitral valve repair in patients with secondary MR are needed to provide information on this patient group.128,129

Figure 2.

Figure 2. Indications for Surgery for MR (Updated Figure 4 From the 2014 VHD guideline).

*MV repair is preferred over MV replacement when possible.

AF indicates atrial fibrillation; CAD, coronary artery disease; CRT, cardiac resynchronization therapy; EF, ejection fraction; ERO, effective regurgitant orifice; HF, heart failure; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; MR, mitral regurgitation; MV, mitral valve; NYHA, New York Heart Association; PASP, pulmonary artery systolic pressure; RF, regurgitant fraction; RVol, regurgitant volume; and Rx, therapy.

Recommendations for Secondary MR Intervention

11. Prosthetic Valves

11.1. Evaluation and Selection of Prosthetic Valves

11.1.2. Intervention: Recommendations

Recommendations for Intervention of Prosthetic Valves

11.2. Antithrombotic Therapy for Prosthetic Valves

11.2.1. Diagnosis and Follow-Up

Effective oral antithrombotic therapy in patients with mechanical heart valves requires continuous VKA anticoagulation with an INR in the target range. It is preferable to specify a single INR target for each patient and to recognize that the acceptable range includes 0.5 INR units on each side of this target. A specific target is preferable because it reduces the likelihood of patients having INR values consistently near the upper or lower boundary of the range. In addition, fluctuations in INR are associated with an increased incidence of complications in patients with prosthetic heart valves, so patients and caregivers should strive to attain the specific INR value.170,171 The effects of VKA anticoagulation vary with the specific drug, absorption, various foods, alcohol, other medications, and changes in liver function. Most of the published studies of VKA therapy used warfarin, although other coumarin agents are used on a worldwide basis. In clinical practice, a program of patient education and close surveillance by an experienced healthcare professional, with periodic INR determinations, is necessary. Patient monitoring through dedicated anticoagulation clinics results in lower complication rates than those seen with standard care and is cost effective because of lower rates of bleeding and hemorrhagic complications.172,173 Periodic direct patient contact and telephone encounters174 with the anticoagulation clinic pharmacists175,176 or nurses are equally effective in reducing complication rates.177 Self-monitoring with home INR measurement devices is another option for educated and motivated patients.

Table 3. Factors Used for Shared Decision Making About Type of Valve Prosthesis

Favor Mechanical ProsthesisFavor Bioprosthesis
Age <50 yAge >70 y
 Increased incidence of structural deterioration with bioprosthesis (15-y risk: 30% for age 40 y, 50% for age 20 y) Low incidence of structural deterioration (15-y risk: <10% for age >70 y)
 Lower risk of anticoagulation complications Higher risk of anticoagulation complications
Patient preference (avoid risk of reintervention) of valve sounds)Patient preference (avoid risk and inconvenience of anticoagulation and absence
Low risk of long-term anticoagulationHigh risk of long-term anticoagulation
Compliant patient with either home monitoring or close access to INR monitoringLimited access to medical care or inability to regulate VKA
Other indication for long-term anticoagulation (eg, AF)Access to surgical centers with low reoperation mortality rate
High-risk reintervention (eg, porcelain aorta, prior radiation therapy)
Small aortic root size for AVR (may preclude valve-in-valve procedure in future).

AF indicates atrial fibrillation; AVR, aortic valve replacement; INR, International Normalized Ratio; and VKA, vitamin K antagonist.

11.2.2. Medical Therapy: Recommendations

Recommendations for Antithrombotic Therapy for Patients with Prosthetic Heart Valves

11.3. Bridging Therapy for Prosthetic Valves

11.3.1. Diagnosis and Follow-Up

The management of patients with mechanical heart valves for whom interruption of anticoagulation therapy is needed for diagnostic or surgical procedures should take into account the type of procedure; bleeding risk; patient risk factors; and type, location, and number of heart valve prostheses.

11.3.2. Medical Therapy: Recommendations

Recommendations for Bridging Therapy for Prosthetic Valves

11.6. Acute Mechanical Prosthetic Valve Thrombosis

11.6.1. Diagnosis and Follow-Up: Recommendation

Recommendation for Mechanical Prosthetic Valve Thrombosis Diagnosis and Follow-Up

11.6.3. Intervention: Recommendation

Recommendation for Mechanical Prosthetic Valve Thrombosis Intervention

11.7. Prosthetic Valve Stenosis

Surgical reoperation to replace the stenotic prosthetic heart valve has been the mainstay treatment modality. Although it is associated with acceptable mortality and morbidity in the current era, it remains a serious clinical event and carries a higher risk than the initial surgery. Reoperation is usually required for moderate-to-severe prosthetic dysfunction (structural and nonstructural), dehiscence, and prosthetic valve endocarditis. Reoperation may also be needed for recurrent thromboembolism, severe intravascular hemolysis, severe recurrent bleeding from anticoagulant therapy, and thrombosed prosthetic valves. In 2015, catheter-based therapy with transcatheter valve-in-valve emerged as an acceptable alternative to treat high- and extreme-risk patients with bioprosthetic aortic valve stenosis (stenosis, insufficiency, or combined) in the absence of active IE.154

Symptomatic prosthetic valve stenosis secondary to thrombosis is observed predominantly with mechanical valves. Mechanical prosthetic valve thrombosis and its treatment are discussed in Section 11.6. Bioprosthetic valve thrombosis can result in thromboembolic events or obstruction. In a pooled analysis from 3 studies including 187 patients who underwent either TAVR or bioprosthetic surgical AVR, reduced leaflet motion was noted on 4-dimensional volume-rendered CT imaging in 21% of patients.203 In this small cohort, therapeutic anticoagulation with warfarin was associated with lower incidence of reduced leaflet motion than that associated with dual antiplatelet therapy, as well as more restoration of leaflet motion on follow-up CT imaging. Subclinical leaflet thrombosis was identified as the likely cause on the basis of advanced and characteristic imaging findings.203 As outlined by the US Food and Drug Administration, most cases of reduced leaflet motion (which occurs in 10% to 40% of TAVR patients and 8% to 12% of surgical AVR patients) were discovered by advanced imaging studies in asymptomatic patients.236 The diagnosis of bioprosthetic valve thrombosis remains difficult, with most suspected bioprosthetic valve thrombosis based on increased transvalvular gradients.

Table 4. Fibrinolysis Versus Surgery for ProstheticValve Thrombosis

Favor SurgeryFavor Fibrinolysis
Readily available surgical expertiseNo surgical expertise available
Low surgical riskHigh surgical risk
Contraindication to fibrinolysisNo contraindication to fibrinolysis
Recurrent valve thrombosisFirst-time episode of valve thrombosis
NYHA class IVNYHA class I–III
Large clot (>0.8 cm2)Small clot (≤0.8 cm2)
Left atrial thrombusNo left atrial thrombus
Concomitant CAD in need of revascularizationNo or mild CAD
Other valve diseaseNo other valve disease
Possible pannusThrombus visualized
Patient choicePatient choice

CAD indicates coronary artery disease; and NYHA, New York Heart Association.

In some patients, the size of the prosthetic valve that can be implanted results in inadequate blood flow to meet the metabolic demands of the patient, even when the prosthetic valve itself is functioning normally. This situation, called patient–prosthesis mismatch (defined as an indexed effective orifice area ≤0.85 cm2/m2 for aortic valve prostheses), is a predictor of a high transvalvular gradient, persistent LV hypertrophy, and an increased rate of cardiac events after AVR.237,238 The impact of a relatively small valve area is most noticeable with severe patient– prosthesis mismatch, defined as an indexed orifice area <0.65 cm2/m2. Patient–prosthesis mismatch is especially detrimental in patients with reduced LVEF and may decrease the likelihood of resolution of symptoms and improvement in LVEF. Patient–prosthesis mismatch can be avoided or reduced by choice of a valve prosthesis that will have an adequate indexed orifice area, determined by the patient’s body size and annular dimension. In some cases, annular enlargement or other approaches may be needed to allow implantation of an appropriately sized valve or avoidance of a prosthetic valve. With bileaflet mechanical valves, patterns of blood flow are complex, and significant pressure recovery may be present; this may result in a high velocity across the prosthesis that should not be mistaken for prosthetic valve stenosis or patient–prosthesis mismatch, particularly in those with small aortic diameters.

11.7.3. Intervention: Recommendation

Recommendations for Prosthetic Valve Stenosis

11.8. Prosthetic Valve Regurgitation

11.8.3. Intervention: Recommendations

Recommendations for Prosthetic Valve Regurgitation

12. Infective Endocarditis

12.2. Infective Endocarditis

12.2.3. Intervention: Recommendations

Recommendations for IE Intervention

ACC/AHA Task Force Members

Glenn N. Levine, MD, FACC, FAHA, Chair; Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect; Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair*; Sana M. Al-Khatib, MD, MHS, FACC, FAHA; Kim K. Birtcher, MS, PharmD, AACC; Biykem Bozkurt, MD, PhD, FACC, FAHA; Ralph G. Brindis, MD, MPH, MACC*; Joaquin E. Cigarroa, MD, FACC; Lesley H. Curtis, PhD, FAHA; Lee A. Fleisher, MD, FACC, FAHA; Federico Gentile, MD, FACC; Samuel Gidding, MD, FAHA; Mark A. Hlatky, MD, FACC; John Ikonomidis, MD, PhD, FAHA; José Joglar, MD, FACC, FAHA; Susan J. Pressler, PhD, RN, FAHA; Duminda N. Wijeysundera, MD, PhD

Presidents and Staff

American College of Cardiology

Richard A. Chazal, MD, FACC, President

Shalom Jacobovitz, Chief Executive Officer

William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education, Quality, and Publishing

Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publishing

American College of Cardiology/American Heart Association

Katherine Sheehan, PhD, Director, Guideline Strategy and Operations

Lisa Bradfield, CAE, Director, Guideline Methodology and Policy

Abdul R. Abdullah, MD, Science and Medicine Advisor

Clara Fitzgerald, Project Manager, Clinical Practice Guidelines

American Heart Association

Steven R. Houser, PhD, FAHA, President

Nancy Brown, Chief Executive Officer

Rose Marie Robertson, MD, FAHA, Chief Science and Medicine Officer

Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice President, Office of Science Operations

Jody Hundley, Production Manager, Scientific Publications, Office of Science Operations

* Former Task Force member; current member during the writing effort.

Footnotes

The American Heart Association requests that this document be cited as follows: Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e1159–e1195. DOI: 10.1161/CIR.0000000000000503.

This document was approved by the American College of Cardiology Clinical Policy Approval Committee on behalf of the Board of Trustees, the American Heart Association Science Advisory and Coordinating Committee in January 2017, and the American Heart Association Executive Committee in February 2017.

The online Comprehensive RWI Data Supplement table is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000503/-/DC1.

The online Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000503/-/DC2.

This article has been copublished in the Journal of the American College of Cardiology.

Copies: This document is available on the World Wide Web sites of the American Heart Association (professional.heart.org) and the American College of Cardiology (www.acc.org). A copy of the document is available at http://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 843-216-2533 or e-mail [email protected].

Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.”

Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page.

Circulation is available at http://circ.ahajournals.org.

References

  • 1. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine (U.S.). Clinical Practice Guidelines We Can Trust. ed. Washington, DC: Press NA, 2011.Google Scholar
  • 2. Committee on Standards for Systematic Reviews of Comparative Effectiveness Research, Institute of Medicine (U.S.). Finding What Works in Health Care: Standards for Systematic Reviews. ed. Washington, DC: Press NA, 2011.Google Scholar
  • 3. Anderson JL, Heidenreich PA, Barnett PG, et al. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines.Circulation. 2014; 129:2329–45.LinkGoogle Scholar
  • 4. ACCF/AHA Task Force on Practice Guidelines Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines. American College of Cardiology and American Heart Association2010. Available at: http://assets.cardiosource.com/Methodology_Manual_for_ACC_AHA_Writing_Committees.pdf. Accessed February 2017.Google Scholar
  • 5. Halperin JL, Levine GN, Al-Khatib SM, Birtcher K, Bozkurt B. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2016; 133:1426–28.LinkGoogle Scholar
  • 6. Jacobs AK, Kushner FG, Ettinger SM, et al. ACCF/AHA clinical practice guideline methodology summit report: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2013; 127:268–310.LinkGoogle Scholar
  • 7. Jacobs AK, Anderson JL, Halperin JL. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 130:1208–17.LinkGoogle Scholar
  • 8. Arnett DK, Goodman RA, Halperin JL, Anderson JL, Parekh AK, Zoghbi WA. AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and U.S. Department of Health and Human Services.Circulation. 2014; 130:1662–7.LinkGoogle Scholar
  • 9. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129:2440–92.LinkGoogle Scholar
  • 10. Nishimura R, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline 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.Circulation. 2014; 129:e521–643.LinkGoogle Scholar
  • 11. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.Circulation. 2007; 116:1736–54.LinkGoogle Scholar
  • 12. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC).Eur Heart J. 2015; 36:3075–128.CrossrefMedlineGoogle Scholar
  • 13. Glenny AM, Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry.Cochrane Database Syst Rev. 2013:CD003813.MedlineGoogle Scholar
  • 14. (NICE) UNIfHaCE. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. Available at: https://www.nice.org.uk/guidance/cg64. Accessed January 20, 2017.Google Scholar
  • 15. Mougeot FKB, Saunders SE, Brennan MT, Lockhart PB. Associations between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119:430–5.CrossrefMedlineGoogle Scholar
  • 16. Desimone DC, Tleyjeh IM, Correa de Sa DD, et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association’s endocarditis prevention guidelines.Circulation. 2012; 126:60–4.LinkGoogle Scholar
  • 17. Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis.Lancet. 2015; 385:1219–28.CrossrefMedlineGoogle Scholar
  • 18. Duval X, Delahaye F, Alla F, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys.J Am Coll Cardiol. 2012; 59:1968–76.CrossrefMedlineGoogle Scholar
  • 19. Pasquali SK, He X, Mohamad Z, et al. Trends in endocarditis hospitalizations at US children’s hospitals: impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines.Am Heart J. 2012; 163:894–9.CrossrefMedlineGoogle Scholar
  • 20. Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011.J Am Coll Cardiol. 2015; 65:2070–6.CrossrefMedlineGoogle Scholar
  • 21. Thornhill MH, Dayer MJ, Forde JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study.BMJ. 2011; 342:d2392.CrossrefMedlineGoogle Scholar
  • 22. Strom BL, Abrutyn E, Berlin JA, et al. Risk factors for infective endocarditis: oral hygiene and nondental exposures.Circulation. 2000; 102:2842–8.LinkGoogle Scholar
  • 23. Sherman-Weber S, Axelrod P, Suh B, et al. Infective endocarditis following orthotopic heart transplantation: 10 cases and a review of the literature.Transpl Infect Dis. 2004; 6:165–70.CrossrefMedlineGoogle Scholar
  • 24. Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction.Circulation. 2008; 117:3118–25.LinkGoogle Scholar
  • 25. Geist SM, Fitzpatrick S, Geist JR. American Heart Association 2007 guidelines on prevention of infective endocarditis.J Mich Dent Assoc. 2007; 89:50–6.MedlineGoogle Scholar
  • 26. Duval X, Alla F, Hoen B, et al. Estimated risk of endocarditis in adults with predisposing cardiac conditions undergoing dental procedures with or without antibiotic prophylaxis.Clin Infect Dis. 2006; 42:e102–7.CrossrefMedlineGoogle Scholar
  • 27. The 2015 ESC Guidelines for the management of infective endocarditis.Eur Heart J. 2015; 36:3036–7.CrossrefMedlineGoogle Scholar
  • 28. Horstkotte D, Rosen H, Friedrichs W, Loogen F. Contribution for choosing the optimal prophylaxis of bacterial endocarditis.Eur Heart J. 1987; 8 suppl J:379–81.CrossrefGoogle Scholar
  • 29. Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study.Ann Intern Med. 1998; 129:761–9.CrossrefMedlineGoogle Scholar
  • 30. Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H, et al. Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry.Circulation. 2015; 131:1566–74.LinkGoogle Scholar
  • 31. Mangner N, Woitek F, Haussig S, et al. Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement.J Am Coll Cardiol. 2016; 67:2907–8.CrossrefMedlineGoogle Scholar
  • 32. Karavas AN, Filsoufi F, Mihaljevic T, Aranki SF, Cohn LH, Byrne JG. Risk factors and management of endocarditis after mitral valve repair.J Heart Valve Dis. 2002; 11:660–4.MedlineGoogle Scholar
  • 33. Gillinov AM, Faber CN, Sabik JF, et al. Endocarditis after mitral valve repair.Ann Thorac Surg. 2002; 73:1813–6.CrossrefMedlineGoogle Scholar
  • 34. Pérez-Gómez F, Alegría E, Berjón J, et al. Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: a randomized multicenter study.J Am Coll Cardiol. 2004; 44:1557–66.CrossrefMedlineGoogle Scholar
  • 35. Noseworthy PA, Yao X, Shah ND, Gersh BJ. Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and valvular heart disease.Int J Cardiol. 2016; 209:181–3.CrossrefMedlineGoogle Scholar
  • 36. Avezum A, Lopes RD, Schulte PJ, et al. Apixaban in comparison with warfarin in patients with atrial fibrillation and valvular heart disease: findings from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.Circulation. 2015; 132:624–32.LinkGoogle Scholar
  • 37. Breithardt G, Baumgartner H, Berkowitz SD, et al. Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial.Eur Heart J. 2014; 35:3377–85.CrossrefMedlineGoogle Scholar
  • 38. Ezekowitz MD, Nagarakanti R, Noack H, et al. Comparison of dabigatran and warfarin in patients with atrial fibrillation and valvular heart disease: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulant Therapy).Circulation. 2016; 134:589–98.LinkGoogle Scholar
  • 39. Aguilar MI, Hart R. Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks.Cochrane Database Syst Rev. 2005;CD001927.MedlineGoogle Scholar
  • 40. Olesen JB, Lip GY.H, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study.BMJ. 2011; 342:d124.CrossrefMedlineGoogle Scholar
  • 41. Lytvyn L, Guyatt GH, Manja V, et al. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review.BMJ Open. 2016; 6:e014327.CrossrefMedlineGoogle Scholar
  • 42. Horstkotte D, Loogen F. The natural history of aortic valve stenosis.Eur Heart J. 1988; 9 Suppl E:57–64.CrossrefMedlineGoogle Scholar
  • 43. O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery.Ann Thorac Surg. 2009; 88:S23–42.CrossrefMedlineGoogle Scholar
  • 44. Freeman RV, Otto CM. Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies.Circulation. 2005; 111:3316–26.LinkGoogle Scholar
  • 45. Kvidal P, Bergström R, Hörte LG, Stahle E. Observed and relative survival after aortic valve replacement.J Am Coll Cardiol. 2000; 35:747–56.CrossrefMedlineGoogle Scholar
  • 46. Murphy ES, Lawson RM, Starr A, Rahimtoola SH. Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement.Circulation. 1981; 64:II184–8.MedlineGoogle Scholar
  • 47. Rosenhek R. Arotic stenosis: disease severity, progression, timing of intervention and role in monitoring transcatheter valve implanation.C.M OttoThe Practice of Clinical Echocardiography4 ed2012Elsevier/SaundersPhiladelphia, PA425–49.Google Scholar
  • 48. Schwarz F, Baumann P, Manthey J, et al. The effect of aortic valve replacement on survival.Circulation. 1982; 66:1105–10.LinkGoogle Scholar
  • 49. Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis.N Engl J Med. 2014; 370:1790–8.CrossrefMedlineGoogle Scholar
  • 50. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.Lancet. 2015; 385:2477–84.CrossrefMedlineGoogle Scholar
  • 51. Deeb GM, Reardon MJ, Chetcuti S, et al. Three-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement.J Am Coll Cardiol. 2016; 67:2565–74.CrossrefMedlineGoogle Scholar
  • 52. Holmes DR, Nishimura RA, Grover FL, et al. Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry.J Am Coll Cardiol. 2015; 66:2813–23.CrossrefMedlineGoogle Scholar
  • 53. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.N Engl J Med. 2012; 366:1696–704.CrossrefMedlineGoogle Scholar
  • 54. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364:2187–98.CrossrefMedlineGoogle Scholar
  • 55. Eltchaninoff H, Prat A, Gilard M, et al. Transcatheter aortic valve implantation: early results of the FRANCE (FRench Aortic National CoreValve and Edwards) registry.Eur Heart J. 2011; 32:191–7.CrossrefMedlineGoogle Scholar
  • 56. Rodés-Cabau J, Webb JG, Cheung A, et al. Long-term outcomes after transcatheter aortic valve implantation: insights on prognostic factors and valve durability from the Canadian multicenter experience.J Am Coll Cardiol. 2012; 60:1864–75.CrossrefMedlineGoogle Scholar
  • 57. Abdel-Wahab M, Neumann FJ, Mehilli J, et al. One-year outcomes after transcatheter aortic valve replacement with balloon-expandable versus self-expandable valves: results from the CHOICE randomized clinical trial.J Am Coll Cardiol. 2015; 66:791–800.CrossrefMedlineGoogle Scholar
  • 58. Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial.Lancet. 2015; 385:2485–91.CrossrefMedlineGoogle Scholar
  • 59. Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.J Am Coll Cardiol. 2014; 63:1972–81.CrossrefMedlineGoogle Scholar
  • 60. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med. 2010; 363:1597–607.CrossrefMedlineGoogle Scholar
  • 61. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement.N Engl J Med. 2012; 366:1686–95.CrossrefMedlineGoogle Scholar
  • 62. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2016; 374:1609–20.CrossrefMedlineGoogle Scholar
  • 63. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis.Lancet. 2016; 387:2218–25.CrossrefMedlineGoogle Scholar
  • 64. Siemieniuk RA, Agoritsas T, Manja V, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis.BMJ. 2016; 356:i5130.CrossrefGoogle Scholar
  • 65. Foroutan F, Guyatt GH, O’Brien K, et al. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies.BMJ. 2016; 354:i5065.CrossrefMedlineGoogle Scholar
  • 66. Vandvik PO, Otto CM, Siemieniuk RA, et al. Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline.BMJ. 2016; 354:i5085.CrossrefMedlineGoogle Scholar
  • 67. Uretsky S, Gillam L, Lang R, et al. Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial.J Am Coll Cardiol. 2015; 65:1078–88CrossrefMedlineGoogle Scholar
  • 68. Grayburn PA, Carabello B, Hung J, et al. Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach.J Am Coll Cardiol. 2014; 64:2792–801.CrossrefMedlineGoogle Scholar
  • 69. Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation.N Engl J Med. 2014; 370:23–32CrossrefMedlineGoogle Scholar
  • 70. Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation.N Engl J Med. 2016; 374:344–53.CrossrefMedlineGoogle Scholar
  • 71. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation.N Engl J Med. 2016; 374:1932–41.CrossrefMedlineGoogle Scholar
  • 72. Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation.N Engl J Med. 2014; 371:2178–88.CrossrefMedlineGoogle Scholar
  • 73. David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease.Circulation. 2013; 127:1485–92.LinkGoogle Scholar
  • 74. Gillinov AM, Mihaljevic T, Blackstone EH, et al. Should patients with severe degenerative mitral regurgitation delay surgery until symptoms develop?. Ann Thorac Surg. 2010; 90:481–8.CrossrefMedlineGoogle Scholar
  • 75. Tribouilloy CM, Enriquez-Sarano M, Schaff HV, et al. Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications.Circulation. 1999; 99:400–5.LinkGoogle Scholar
  • 76. Crawford MH, Souchek J, Oprian CA, et al. Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease.Circulation. 1990; 81:1173–81.LinkGoogle Scholar
  • 77. Enriquez-Sarano M, Tajik AJ, Schaff HV, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications.J Am Coll Cardiol. 1994; 24:1536–43.CrossrefMedlineGoogle Scholar
  • 78. Grigioni F, Enriquez-Sarano M, Ling LH, et al. Sudden death in mitral regurgitation due to flail leaflet.J Am Coll Cardiol. 1999; 34:2078–85.CrossrefMedlineGoogle Scholar
  • 79. Grigioni F, Tribouilloy C, Avierinos JF, et al. Outcomes in mitral regurgitation due to flail leaflets a multicenter European study.J Am Coll Cardiol Img. 2008; 1:133–41.CrossrefGoogle Scholar
  • 80. Schuler G, Peterson KL, Johnson A, et al. Temporal response of left ventricular performance to mitral valve surgery.Circulation. 1979; 59:1218–31LinkGoogle Scholar
  • 81. Starling MR. Effects of valve surgery on left ventricular contractile function in patients with long-term mitral regurgitation.Circulation. 1995; 92:811–8.LinkGoogle Scholar
  • 82. Tribouilloy C, Grigioni F, Avierinos JF, et al. Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study.J Am Coll Cardiol. 2009; 54:1961–8.CrossrefMedlineGoogle Scholar
  • 83. STS online risk calculator. Available at: http://riskcalcstsorg/stswebriskcalc Accessed January 20, 2017.Google Scholar
  • 84. Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency.Circulation. 2001; 104:I8–1.CrossrefMedlineGoogle Scholar
  • 85. Cohn LH. Surgery for mitral regurgitation.JAMA. 1988; 260:2883–7.CrossrefMedlineGoogle Scholar
  • 86. Cosgrove DM, Chavez AM, Lytle BW, et al. Results of mitral valve reconstruction.Circulation. 1986; 74:I82–7.MedlineGoogle Scholar
  • 87. David TE, Uden DE, Strauss HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation.Circulation. 1983; 68:II76–82.MedlineGoogle Scholar
  • 88. David TE, Burns RJ, Bacchus CM, Druck MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae.J Thorac Cardiovasc Surg. 1984; 88:718–25.CrossrefMedlineGoogle Scholar
  • 89. David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.J Thorac Cardiovasc Surg. 2005; 130:1242–9.CrossrefMedlineGoogle Scholar
  • 90. Gammie JS, Sheng S, Griffith BP, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.Ann Thorac Surg. 2009; 87:1431–7; discussion 7–349.CrossrefMedlineGoogle Scholar
  • 91. Goldman KE. Dental management of patients with bone marrow and solid organ transplantation.Dent Clin North Am. 2006; 50:659–76viii.CrossrefMedlineGoogle Scholar
  • 92. Hansen DE, Sarris GE, Niczyporuk MA, Derby GC, Cahill PD, Miller DC. Physiologic role of the mitral apparatus in left ventricular regional mechanics, contraction synergy, and global systolic performance.J Thorac Cardiovasc Surg. 1989; 97:521–33.CrossrefMedlineGoogle Scholar
  • 93. Hennein HA, Swain JA, McIntosh CL, Bonow RO, Stone CD, Clark RE. Comparative assessment of chordal preservation versus chordal resection during mitral valve replacement.J Thorac Cardiovasc Surg. 1990; 99:828–36; discussion 36–7.CrossrefMedlineGoogle Scholar
  • 94. Horskotte D, Schulte HD, Bircks W, Strauer BE. The effect of chordal preservation on late outcome after mitral valve replacement: a randomized study.J Heart Valve Dis. 1993; 2:150–8.MedlineGoogle Scholar
  • 95. McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: early outcomes, late outcomes, and echocardiographic follow-up.J Thorac Cardiovasc Surg. 2013; 145:1199–206.CrossrefMedlineGoogle Scholar
  • 96. Rozich JD, Carabello BA, Usher BW, Kratz JM, Bell AE, Zile MR. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance.Circulation. 1992; 86:1718–26.LinkGoogle Scholar
  • 97. Rushmer RF. Initial phase of ventricular systole: asynchronous contraction.Am J Physiol. 1956; 184:188–94.CrossrefMedlineGoogle Scholar
  • 98. Sarris GE, Cahill PD, Hansen DE, Derby GC, Miller DC. Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. The importance of valvular-ventricular interaction.J Thorac Cardiovasc Surg. 1988; 95:969–79.CrossrefMedlineGoogle Scholar
  • 99. Vassileva CM, Mishkel G, McNeely C, et al. Long-term survival of patients undergoing mitral valve repair and replacement: a longitudinal analysis of Medicare fee-for-service beneficiaries.Circulation. 2013; 127:1870–6.LinkGoogle Scholar
  • 100. Badhwar V, Peterson ED, Jacobs JP, et al. Longitudinal outcome of isolated mitral repair in older patients: results from 14,604 procedures performed from 1991 to 2007.Ann Thorac Surg. 2012; 94:1870–9.CrossrefMedlineGoogle Scholar
  • 101. Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS. Predictors of mitral valve repair: clinical and surgeon factors.Ann Thorac Surg. 2010; 90:1904–11; discussion 12.CrossrefMedlineGoogle Scholar
  • 102. Chauvaud S, Fuzellier JF, Berrebi A, Deloche A, Fabiani JN, Carpentier A. Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency.Circulation. 2001; 104:I12–5.CrossrefMedlineGoogle Scholar
  • 103. Chikwe J, Goldstone AB, Passage J, et al. A propensity score-adjusted retrospective comparison of early and mid-term results of mitral valve repair versus replacement in octogenarians.Eur Heart J. 2011; 32:618–26.CrossrefMedlineGoogle Scholar
  • 104. Grossi EA, Galloway AC, Miller JS, et al. Valve repair versus replacement for mitral insufficiency: when is a mechanical valve still indicated?.J Thorac Cardiovasc Surg. 1998; 115:389–96.CrossrefMedlineGoogle Scholar
  • 105. Gillinov AM, Blackstone EH, Cosgrove DM, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement.J Thorac Cardiovasc Surg. 2003; 125:1372–87.CrossrefMedlineGoogle Scholar
  • 106. Suri RM, Vanoverschelde JL, Grigioni F, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets.JAMA. 2013; 310:609–16.CrossrefMedlineGoogle Scholar
  • 107. Rosenhek R, Rader F, Klaar U, et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation.Circulation. 2006; 113:2238–44.LinkGoogle Scholar
  • 108. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease.J Thorac Cardiovasc Surg. 2008; 135:885–9393.e1–2.CrossrefMedlineGoogle Scholar
  • 109. Duran CM, Gometza B, Saad E. Valve repair in rheumatic mitral disease: an unsolved problem.J Card Surg. 1994; 9:282–5.CrossrefMedlineGoogle Scholar
  • 110. Suri RM, Schaff HV, Dearani JA, et al. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse.J Thorac Cardiovasc Surg. 2009; 137:1071–6.CrossrefMedlineGoogle Scholar
  • 111. Kang DH, Kim JH, Rim JH, et al. Comparison of early surgery versus conventional treatment in asymptomatic severe mitral regurgitation.Circulation. 2009; 119:797–804.LinkGoogle Scholar
  • 112. Tribouilloy C, Rusinaru D, Szymanski C, et al. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction.Eur J Echocardiogr. 2011; 112:702–10.CrossrefGoogle Scholar
  • 113. Enriquez-Sarano M, Suri RM, Clavel MA, et al. Is there an outcome penalty linked to guideline-based indications for valvular surgery? Early and long-term analysis of patients with organic mitral regurgitation.J Thorac Cardiovasc Surg. 2015; 150:50–8.CrossrefMedlineGoogle Scholar
  • 114. Quintana E, Suri RM, Thalji NM, et al. Left ventricular dysfunction after mitral valve repair—the fallacy of “normal” preoperative myocardial function.J Thorac Cardiovasc Surg. 2014; 148:2752–60.CrossrefMedlineGoogle Scholar
  • 115. Suri RM, Schaff HV, Dearani JA, et al. Determinants of early decline in ejection fraction after surgical correction of mitral regurgitation.J Thorac Cardiovasc Surg. 2008; 136:442–7.CrossrefMedlineGoogle Scholar
  • 116. Naji P, Griffin BP, Barr T, et al. Importance of exercise capacity in predicting outcomes and determining optimal timing of surgery in significant primary mitral regurgitation.J Am Heart Assoc. 2014; 3:e001010LinkGoogle Scholar
  • 117. Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique.J Thorac Cardiovasc Surg. 1991; 101:584–92.CrossrefMedlineGoogle Scholar
  • 118. Ghoreishi M, Evans CF, DeFilippi CR, et al. Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: implications for timing of surgery.J Thorac Cardiovasc Surg. 2011; 142:1439–52.CrossrefMedlineGoogle Scholar
  • 119. Kawaguchi AT, Kosakai Y, Sasako Y, Eishi K, Nakano K, Kawashima Y. Risks and benefits of combined maze procedure for atrial fibrillation associated with organic heart disease.J Am Coll Cardiol. 1996; 28:985–90.CrossrefMedlineGoogle Scholar
  • 120. Kobayashi J, Kosakai Y, Isobe F, et al. Rationale of the Cox Maze procedure for atrial fibrillation during redo mitral valve operations.J Thorac Cardiovasc Surg. 1996; 112:1216–21; discussion 22.CrossrefMedlineGoogle Scholar
  • 121. Ngaage DL, Schaff HV, Mullany CJ, et al. Influence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified?.Ann Thorac Surg. 2007; 84:434–42; discussion 42–3.CrossrefMedlineGoogle Scholar
  • 122. Olasinska-Wisniewska A, Mularek-Kubzdela T, Grajek S, et al. Impact of atrial remodeling on heart rhythm after radiofrequency ablation and mitral valve operations.Ann Thorac Surg. 2012; 93:1449–55.CrossrefMedlineGoogle Scholar
  • 123. Raine D, Dark J, Bourke JP. Effect of mitral valve repair/replacement surgery on atrial arrhythmia behavior.J Heart Valve Dis. 2004; 13:615–21.MedlineGoogle Scholar
  • 124. Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation.N Engl J Med. 2011; 364:1395–406.CrossrefMedlineGoogle Scholar
  • 125. Fattouch K, Guccione F, Sampognaro R, et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial.J Thorac Cardiovasc Surg. 2009; 364:278–85.CrossrefGoogle Scholar
  • 126. Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study.J Am Coll Cardiol. 2012; 59:130–9.CrossrefMedlineGoogle Scholar
  • 127. Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction.J Am Coll Cardiol. 2005; 45:381–7.CrossrefMedlineGoogle Scholar
  • 128. Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations.J Am Coll Cardiol. 2015; 65:1231–48.CrossrefMedlineGoogle Scholar
  • 129. Obadia JF, Armoiry X, Iung B, et al. The MITRA-FR study: design and rationale of a randomised study of percutaneous mitral valve repair compared with optimal medical management alone for severe secondary mitral regurgitation.EuroIntervention. 2015; 10:1354–60.CrossrefMedlineGoogle Scholar
  • 130. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment.Circulation. 2001; 103:1759–64.LinkGoogle Scholar
  • 131. Lancellotti P, Gérard PL, Piérard LA. Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation.Eur Heart J. 2005; 26:1528–32.CrossrefMedlineGoogle Scholar
  • 132. Trichon BH, Felker GM, Shaw LK, Cabell CH, O’Connor CM. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure.Am J Cardiol. 2003; 91:538–43.CrossrefMedlineGoogle Scholar
  • 133. Rossi A, Dini FL, Faggiano P, et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.Heart. 2011; 97:1675–80.CrossrefMedlineGoogle Scholar
  • 134. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation.J Am Coll Cardiol. 2007; 49:2191–201.CrossrefMedlineGoogle Scholar
  • 135. Harris KM, Sundt TM, Aeppli D, Sharma R, Barzilai B. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve?.Ann Thorac Surg. 2002; 74:1468–75.CrossrefMedlineGoogle Scholar
  • 136. Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients.J Cardiovasc Med (Hagerstown). 2009; 10:109–14.CrossrefMedlineGoogle Scholar
  • 137. Deja MA, Grayburn PA, Sun B, et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial.Circulation. 2012; 125:2639–48.LinkGoogle Scholar
  • 138. Cohn LH, Rizzo RJ, Adams DH, et al. The effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement.Eur J Cardiothorac Surg. 1995; 9:568–74.CrossrefMedlineGoogle Scholar
  • 139. Chan KMJ, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial.Circulation. 2012; 126:2502–10.LinkGoogle Scholar
  • 140. Lim DS, Reynolds MR, Feldman T, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair.J Am Coll Cardiol. 2013; 64:182–92.CrossrefMedlineGoogle Scholar
  • 141. van Geldorp MW.A, Eric Jamieson WR, Kappetein AP, et al. Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: weighing lifetime anticoagulant-related event risk against reoperation risk.J Thorac Cardiovasc Surg. 2009; 137:881–66e1–5.CrossrefMedlineGoogle Scholar
  • 142. Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50–69 years.Eur Heart J. 2016; 37:2658–67.CrossrefMedlineGoogle Scholar
  • 143. Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years.JAMA. 2015; 313:1435–42.CrossrefMedlineGoogle Scholar
  • 144. McClure RS, McGurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis.J Thorac Cardiovasc Surg. 2014; 148:1931–9.CrossrefMedlineGoogle Scholar
  • 145. Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years.JAMA. 2014; 312:1323–9.CrossrefMedlineGoogle Scholar
  • 146. Repack A, Ziganshin BA, Elefteriades JA, Mukherjee SK. Comparison of quality of life perceived by patients with bioprosthetic versus mechanical valves after composite aortic root replacement.Cardiology. 2016; 133:3–9.CrossrefMedlineGoogle Scholar
  • 147. Dunning J, Gao H, Chambers J, et al. Aortic valve surgery: marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the Society for Cardiothoracic Surgery in Great Britain and Ireland National database.J Thorac Cardiovasc Surg. 2011; 142:776–82.e3.CrossrefMedlineGoogle Scholar
  • 148. Rahimtoola SH. Choice of prosthetic heart valve in adults an update.J Am Coll Cardiol. 2010; 55:2413–26CrossrefMedlineGoogle Scholar
  • 149. Weber A, Noureddine H, Englberger L, et al. Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age.J Thorac Cardiovasc Surg. 2012; 144:1075–83.CrossrefMedlineGoogle Scholar
  • 150. Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position.Ann Thorac Surg. 2015; 99:831–7.CrossrefMedlineGoogle Scholar
  • 151. Bourguignon T, Bouquiaux-Stablo AL, Loardi C, et al. Very late outcomes for mitral valve replacement with the Carpentier-Edwards pericardial bioprosthesis: 25-year follow-up of 450 implantations.J Thorac Cardiovasc Surg. 2014; 148:2004–11.e1.CrossrefMedlineGoogle Scholar
  • 152. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves: an eight-year single-center experience.J Am Coll Cardiol Intv. 2015; 8:1735–44.CrossrefGoogle Scholar
  • 153. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry.Circulation. 2012; 126:2335–44LinkGoogle Scholar
  • 154. Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.JAMA. 2014; 312:162–70.CrossrefMedlineGoogle Scholar
  • 155. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial.J Am Coll Cardiol. 2000; 36:1152–8.CrossrefMedlineGoogle Scholar
  • 156. Chan V, Jamieson WR.E, Germann E, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement.J Thorac Cardiovasc Surg. 2006; 131:1267–73.CrossrefMedlineGoogle Scholar
  • 157. Kaneko T, Aranki S, Javed Q, et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old.J Thorac Cardiovasc Surg. 2014; 147:117–26.CrossrefMedlineGoogle Scholar
  • 158. Badhwar V, Ofenloch JC, Rovin JD, van Gelder HM, Jacobs JP. Noninferiority of closely monitored mechanical valves to bioprostheses overshadowed by early mortality benefit in younger patients.Ann Thorac Surg. 2012; 93:748–53.CrossrefMedlineGoogle Scholar
  • 159. Brown ML, Schaff HV, Lahr BD, et al. Aortic valve replacement in patients aged 50 to 70 years: improved outcome with mechanical versus biologic prostheses.J Thorac Cardiovasc Surg. 2008; 135:878–84; discussion 84.CrossrefMedlineGoogle Scholar
  • 160. Kulik A, Bédard P, Lam BK, et al. Mechanical versus bioprosthetic valve replacement in middle-aged patients.Eur J Cardiothorac Surg. 2006; 30:485–91.CrossrefMedlineGoogle Scholar
  • 161. Bourguignon T, El Khoury R, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount aortic valve in patients aged 60 or younger.Ann Thorac Surg. 2015; 100:853–9.CrossrefMedlineGoogle Scholar
  • 162. McClure RS, Narayanasamy N, Wiegerinck E, et al. Late outcomes for aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1,000 patients.Ann Thorac Surg. 2010; 89:1410–6.CrossrefMedlineGoogle Scholar
  • 163. Banbury MK, Cosgrove DM, Thomas JD, et al. Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis.Ann Thorac Surg. 2002; 73:1460–5.CrossrefMedlineGoogle Scholar
  • 164. Borger MA, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel CM, David TE. Twenty-year results of the Hancock II bioprosthesis.J Heart Valve Dis. 2006; 15:49–55; discussion 6.MedlineGoogle Scholar
  • 165. Dellgren G, David TE, Raanani E, Armstrong S, Ivanov J, Rakowski H. Late hemodynamic and clinical outcomes of aortic valve replacement with the Carpentier-Edwards Perimount pericardial bioprosthesis.J Thorac Cardiovasc Surg. 2002; 124:146–54.CrossrefMedlineGoogle Scholar
  • 166. Mykén PS, Bech-Hansen O. A 20-year experience of 1712 patients with the Biocor porcine bioprosthesis.J Thorac Cardiovasc Surg. 2009; 137:76–81.CrossrefMedlineGoogle Scholar
  • 167. Charitos EI, Takkenberg JJ.M, Hanke T, et al. Reoperations on the pulmonary autograft and pulmonary homograft after the Ross procedure: an update on the German Dutch Ross Registry.J Thorac Cardiovasc Surg. 2012; 144:813–21; discussion 21–3.CrossrefMedlineGoogle Scholar
  • 168. El-Hamamsy I, Eryigit Z, Stevens LM, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial.Lancet. 2010; 376:524–31.CrossrefMedlineGoogle Scholar
  • 169. Mokhles MM, Rizopoulos D, Andrinopoulou ER, et al. Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study.Eur Heart J. 2012; 33:2213–24.CrossrefMedlineGoogle Scholar
  • 170. Edmunds LHThrombotic and bleeding complications of prosthetic heart valves.Ann Thorac Surg. 1987; 44:430–45.CrossrefMedlineGoogle Scholar
  • 171. Tiede DJ, Nishimura RA, Gastineau DA, Mullany CJ, Orszulak TA, Schaff HV. Modern management of prosthetic valve anticoagulation.Mayo Clin Proc. 1998; 73:665–80.CrossrefMedlineGoogle Scholar
  • 172. Aziz F, Corder M, Wolffe J, Comerota AJ. Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care.J Vasc Surg. 2011; 54:1404–7.CrossrefMedlineGoogle Scholar
  • 173. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs.Arch Intern Med. 1998; 158:1641–7.CrossrefMedlineGoogle Scholar
  • 174. Wittkowsky AK, Nutescu EA, Blackburn J, et al. Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting.Chest. 2006; 134:1385–9.CrossrefGoogle Scholar
  • 175. Lalonde L, Martineau J, Blais N, et al. Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial.Am Heart J. 2008; 156:148–54.CrossrefMedlineGoogle Scholar
  • 176. Witt DM, Sadler MA, Shanahan RL, Mazzoli G, Tillman DJ. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy.Chest. 2005; 127:1515–22.CrossrefMedlineGoogle Scholar
  • 177. Locke C, Ravnan SL, Patel R, Uchizono JA. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service.Pharmacotherapy. 2005; 25:685–9.CrossrefMedlineGoogle Scholar
  • 178. Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141:e576S–600.Google Scholar
  • 179. Cannegieter SC, Rosendaal FR, Briët E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses.Circulation. 1994; 89:635–41.LinkGoogle Scholar
  • 180. Cannegieter SC, Rosendaal FR, Wintzen AR, van der Meer FJ, Vandenbroucke JP, Briet E. Optimal oral anticoagulant therapy in patients with mechanical heart valves.N Engl J Med. 1995; 333:11–7.CrossrefMedlineGoogle Scholar
  • 181. Schlitt A, von Bardeleben RS, Ehrlich A, et al. Clopidogrel and aspirin in the prevention of thromboembolic complications after mechanical aortic valve replacement (CAPTA).Thromb Res. 2003; 109:131–5.CrossrefMedlineGoogle Scholar
  • 182. Stein PD, Alpert JS, Bussey HI, Dalen JE, Turpie AG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves.Chest. 2001; 119:220S–7S.CrossrefMedlineGoogle Scholar
  • 183. Sun JCJ, Davidson MJ, Lamy A, Eikelboom JW. Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends.Lancet. 2009; 374:565–76.CrossrefMedlineGoogle Scholar
  • 184. Acar J, Iung B, Boissel JP, et al. AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves.Circulation. 1996; 94:2107–12.LinkGoogle Scholar
  • 185. Hering D, Piper C, Bergemann R, et al. Thromboembolic and bleeding complications following St. Jude Medical valve replacement: results of the German Experience With Low-Intensity Anticoagulation Study.Chest. 2005; 127:53–9.CrossrefMedlineGoogle Scholar
  • 186. Torella M, Torella D, Chiodini P, et al. LOWERing the INtensity of oral anticoaGulant Therapy in patients with bileaflet mechanical aortic valve replacement: results from the “LOWERING-IT” Trial.Am Heart J. 2010; 160:171–8.CrossrefMedlineGoogle Scholar
  • 187. Horstkotte D, Scharf RE, Schultheiss HP. Intracardiac thrombosis: patient-related and device-related factors.J Heart Valve Dis. 1995; 4:114–20.MedlineGoogle Scholar
  • 188. Pruefer D, Dahm M, Dohmen G, Horstkotte D, Bergemann R, Oelert H. Intensity of oral anticoagulation after implantation of St. Jude Medical mitral or multiple valve replacement: lessons learned from GELIA (GELIA 5).Eur Heart JSuppl. 2001;3 Suppl Q:Q39–43.CrossrefGoogle Scholar
  • 189. Meschengieser SS, Fondevila CG, Frontroth J, Santarelli MT, Lazzari MA. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves.J Thorac Cardiovasc Surg. 1997; 113:910–6CrossrefMedlineGoogle Scholar
  • 190. Turpie AG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement.N Engl J Med. 1993; 329:524–9.CrossrefMedlineGoogle Scholar
  • 191. Aramendi JI, Mestres CA, Campos V, Martinez-Leon J, Munoz G, Navas C. Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial.Eur J Cardiothorac Surg. 2005; 27:854–60.CrossrefMedlineGoogle Scholar
  • 192. Colli A, Mestres CA, Castella M, Gherli T. Comparing warfarin to aspirin (WoA) after aortic valve replacement with the St. Jude Medical Epic heart valve bioprosthesis: results of the WoA Epic pilot trial.J Heart Valve Dis. 2007; 16:667–71.MedlineGoogle Scholar
  • 193. Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement.J Am Coll Cardiol. 1995; 25:1111–9.CrossrefMedlineGoogle Scholar
  • 194. Nuñez L, Gil Aguado M, Larrea JL, Celemin D, Oliver J. Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis.Ann Thorac Surg. 1984; 37:84–7.CrossrefMedlineGoogle Scholar
  • 195. Brennan JM, Edwards FH, Zhao Y, et al. Early anticoagulation of bioprosthetic aortic valves in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database.J Am Coll Cardiol. 2012; 60:971–7.CrossrefMedlineGoogle Scholar
  • 196. Egbe AC, Pislaru SV, Pellikka PA, et al. Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors.J Am Coll Cardiol. 2015; 66:2285–94.CrossrefMedlineGoogle Scholar
  • 197. Mérie C, Køber L, Skov Olsen P, et al. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding.JAMA. 2012; 308:2118–25.CrossrefMedlineGoogle Scholar
  • 198. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation.N Engl J Med. 2009; 361:1139–51.CrossrefMedlineGoogle Scholar
  • 199. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation.N Engl J Med. 2015; 373:823–33.CrossrefMedlineGoogle Scholar
  • 200. Eikelboom JW, Connolly SJ, Brueckmann M, et al. Dabigatran versus warfarin in patients with mechanical heart valves.N Engl J Med. 2013; 369:1206–14.CrossrefMedlineGoogle Scholar
  • 201. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2013; 369:2093–104.CrossrefMedlineGoogle Scholar
  • 202. Granger CB, Alexander JH, McMurray JJ.V, et al. Apixaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2011; 365:981–92.CrossrefMedlineGoogle Scholar
  • 203. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves.N Engl J Med. 2015; 373:2015–24.CrossrefMedlineGoogle Scholar
  • 204. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N Engl J Med. 2011; 365:883–91.CrossrefMedlineGoogle Scholar
  • 205. Sundt TM, Zehr KJ, Dearani JA, et al. Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement?.J Thorac Cardiovasc Surg. 2005; 129:1024–31.CrossrefMedlineGoogle Scholar
  • 206. Russo A, Grigioni F, Avierinos JF, et al. Thromboembolic complications after surgical correction of mitral regurgitation incidence, predictors, and clinical implications.J Am Coll Cardiol. 2008; 51:1203–11.CrossrefMedlineGoogle Scholar
  • 207. ElBardissi AW, DiBardino DJ, Chen FY, Yamashita MH, Cohn LH. Is early antithrombotic therapy necessary in patients with bioprosthetic aortic valves in normal sinus rhythm?.J Thorac Cardiovasc Surg. 2010; 139:1137–45.CrossrefMedlineGoogle Scholar
  • 208. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2016; 134:e123–55.LinkGoogle Scholar
  • 209. Puskas J, Gerdisch M, Nichols D, et al. Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized On-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial.J Thorac Cardiovasc Surg. 2014; 147:1202–10; discussion 10–1.CrossrefMedlineGoogle Scholar
  • 210. Hansson NC, Grove EL, Andersen HR, et al. Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications.J Am Coll Cardiol. 2016; 68:2059–69.CrossrefMedlineGoogle Scholar
  • 211. Pache G, Schoechlin S, Blanke P, et al. Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves.Eur Heart J. 2016; 37:2263–71.CrossrefMedlineGoogle Scholar
  • 212. FDA Drug Safety Communication: Pradaxa (dabigatran etexilate mesylate) should not be used in patients with mechanical prosthetic heart valves.December 19, 2012. 2012.Google Scholar
  • 213. Van de Werf F, Brueckmann M, Connolly SJ, et al. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: THE Randomized, phase II study to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN).Am Heart J. 2012; 163:931–7.e1.CrossrefMedlineGoogle Scholar
  • 214. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Erratum. Chest. 2012; 141:e326S–350.CrossrefMedlineGoogle Scholar
  • 215. Pengo V, Palareti G, Cucchini U, et al. Low-intensity oral anticoagulant plus low-dose aspirin during the first six months versus standard-intensity oral anticoagulant therapy after mechanical heart valve replacement: a pilot study of low-intensity warfarin and aspirin in cardiac prostheses (LIWACAP).Clin Appl Thromb Hemost. 2007; 13:241–8.CrossrefMedlineGoogle Scholar
  • 216. Barbetseas J, Nagueh SF, Pitsavos C, Toutouzas PK, Quinones MA, Zoghbi WA. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters.J Am Coll Cardiol. 1998; 32:1410–7.CrossrefMedlineGoogle Scholar
  • 217. Gündüz S, özkan M, Kalçik M, et al. Sixty-four-section cardiac computed tomography in mechanical prosthetic heart valve dysfunction: thrombus or pannus.Circ Cardiovasc Imaging. 2015; 8:e003246.LinkGoogle Scholar
  • 218. Cianciulli TE, Lax JA, Beck MA, et al. Cinefluoroscopic assessment of mechanical disc prostheses: its value as a complementary method to echocardiography.J Heart Valve Dis. 2005; 14:664–73.MedlineGoogle Scholar
  • 219. Montorsi P, De Bernardi F, Muratori M, Cavoretto D, Pepi M. Role of cine-fluoroscopy, transthoracic, and transesophageal echocardiography in patients with suspected prosthetic heart valve thrombosis.Am J Cardiol. 2000; 85:58–64.CrossrefMedlineGoogle Scholar
  • 220. Muratori M, Montorsi P, Teruzzi G, et al. Feasibility and diagnostic accuracy of quantitative assessment of mechanical prostheses leaflet motion by transthoracic and transesophageal echocardiography in suspected prosthetic valve dysfunction.Am J Cardiol. 2006; 97:94–100.CrossrefMedlineGoogle Scholar
  • 221. Suh YJ, Lee S, Im DJ, et al. Added value of cardiac computed tomography for evaluation of mechanical aortic valve: emphasis on evaluation of pannus with surgical findings as standard reference.Int J Cardiol. 2016; 214:454–60.CrossrefMedlineGoogle Scholar
  • 222. Symersky P, Budde RPJ, de Mol BAJM, Prokop M. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction.Am J Cardiol. 2009; 104:1128–34.CrossrefMedlineGoogle Scholar
  • 223. Gürsoy OM, Karakoyun S, Kalçik M, Ozkan M. The incremental value of RT three-dimensional TEE in the evaluation of prosthetic mitral valve ring thrombosis complicated with thromboembolism.Echocardiography. 2013; 30:E198–201.CrossrefMedlineGoogle Scholar
  • 224. Tong AT, Roudaut R, özkan M, et al. Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry.J Am Coll Cardiol. 2004; 43:77–84.CrossrefMedlineGoogle Scholar
  • 225. Keuleers S, Herijgers P, Herregods MC, et al. Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis.Am J Cardiol. 2011; 107:275–9.CrossrefMedlineGoogle Scholar
  • 226. Roudaut R, Lafitte S, Roudaut MF, et al. Management of prosthetic heart valve obstruction: fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases.Arch Cardiovasc Dis. 2009; 102:269–77.CrossrefMedlineGoogle Scholar
  • 227. Karthikeyan G, Math RS, Mathew N, et al. Accelerated infusion of streptokinase for the treatment of left-sided prosthetic valve thrombosis: a randomized controlled trial.Circulation. 2009; 120:1108–14.LinkGoogle Scholar
  • 228. Cáceres-Lóriga FM, Pérez-López H, Morlans-Hernandez K, et al. Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients.J Thromb Thrombolysis. 2006; 21:185–90.CrossrefMedlineGoogle Scholar
  • 229. özkan M, Gündüz S, Biteker M, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial.J Am Coll Cardiol Img. 2013; 6:206–16.CrossrefGoogle Scholar
  • 230. Nagy A, Dénes M, Lengyel M. Predictors of the outcome of thrombolytic therapy in prosthetic mitral valve thrombosis: a study of 62 events.J Heart Valve Dis. 2009; 18:268–75.MedlineGoogle Scholar
  • 231. özkan M, çakal B, Karakoyun S, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low-dose, slow infusion of tissue-type plasminogen activator.Circulation. 2013; 128:532–40.LinkGoogle Scholar
  • 232. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management.J Am Coll Cardiol. 1991; 17:646–50.CrossrefMedlineGoogle Scholar
  • 233. Karthikeyan G, Senguttuvan NB, Joseph J, Devasenapathy N, Bahl VK, Airan B. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies.Eur Heart J. 2013; 34:1557–66.CrossrefMedlineGoogle Scholar
  • 234. Huang G, Schaff HV, Sundt TM, Rahimtoola SH. Treatment of obstructive thrombosed prosthetic heart valve.J Am Coll Cardiol. 2013; 62:1731–6.CrossrefMedlineGoogle Scholar
  • 235. Özkan M, Gündüz S, Gürsoy OM, et al. Ultraslow thrombolytic therapy: a novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial.Am Heart J. 2015; 170:409–18.CrossrefMedlineGoogle Scholar
  • 236. Laschinger JC, Wu C, Ibrahim NG, Shuren JE. Reduced leaflet motion in bioprosthetic aortic valves—the FDA perspective.N Engl J Med. 2015; 373:1996–8.CrossrefMedlineGoogle Scholar
  • 237. Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management.Circulation. 2009; 119:1034–48.LinkGoogle Scholar
  • 238. Koene BM, Soliman Hamad MA, Bouma W, et al. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement.J Cardiothorac Surg. 2013; 8:96.CrossrefMedlineGoogle Scholar
  • 239. Maganti M, Rao V, Armstrong S, Feindel CM, Scully HE, David TE. Redo valvular surgery in elderly patients.Ann Thorac Surg. 2009; 87:521–5.CrossrefMedlineGoogle Scholar
  • 240. Leontyev S, Borger MA, Davierwala P, et al. Redo aortic valve surgery: early and late outcomes.Ann Thorac Surg. 2011; 91:1120–6.CrossrefMedlineGoogle Scholar
  • 241. Kaneko T, Vassileva CM, Englum B, et al. Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures.Ann Thorac Surg. 2015; 100:1298–304; discussion 304.CrossrefMedlineGoogle Scholar
  • 242. Jander N, Kienzle RP, Kayser G, Neumann FJ, Gohlke-Baerwolf C, Minners J. Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position.Am J Cardiol. 2012; 109:257–62.CrossrefMedlineGoogle Scholar
  • 243. Butnaru A, Shaheen J, Tzivoni D, Tauber R, Bitran D, Silberman S. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation.Am J Cardiol. 2013; 112:1439–44.CrossrefMedlineGoogle Scholar
  • 244. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic challenges and treatment opportunities in bioprosthetic valve thrombosis: lessons from a case series.Eur J Cardiothorac Surg. 2015; 47:725–32.CrossrefMedlineGoogle Scholar
  • 245. De Marchena E, Mesa J, Pomenti S, et al. Thrombus formation following transcatheter aortic valve replacement.J Am Coll Cardiol Intv. 2015; 8:728–39.CrossrefGoogle Scholar
  • 246. Latib A, Naganuma T, Abdel-Wahab M, et al. Treatment and clinical outcomes of transcatheter heart valve thrombosis.Circ Cardiovasc Interv. 2015; 8.LinkGoogle Scholar
  • 247. Webb JG, Wood DA, Ye J, et al. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves.Circulation. 2010; 121:1848–57.LinkGoogle Scholar
  • 248. Phan K, Zhao DF, Wang N, Huo YR, Di EM, Yan TD. Transcatheter valve-in-valve implantation versus reoperative conventional aortic valve replacement: a systematic review.J Thorac Dis. 2016; 8:E83–93.MedlineGoogle Scholar
  • 249. Administration USFaD. FDA expands use of CoreValue System for aortic “valve-in-valve replacement”.March 30, 2015. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm440535.htm. Accessed January 20, 2017.Google Scholar
  • 250. Akins CW, Bitondo JM, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks.J Heart Valve Dis. 2005; 14:792–9; discussion 9–800.MedlineGoogle Scholar
  • 251. Miller DL, Morris JJ, Schaff HV, Mullany CJ, Nishimura RA, Orszulak TA. Reoperation for aortic valve periprosthetic leakage: identification of patients at risk and results of operation.J Heart Valve Dis. 1995; 4:160–5.MedlineGoogle Scholar
  • 252. Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks.J Am Coll Cardiol. 2011; 58:2210–7.CrossrefMedlineGoogle Scholar
  • 253. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients.Circ Cardiovasc Interv. 2011; 4:314–21.LinkGoogle Scholar
  • 254. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation.J Am Coll Cardiol. 2011; 58:2218–24.CrossrefMedlineGoogle Scholar
  • 255. Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach.Arch Intern Med. 2009; 169:1290–8.CrossrefMedlineGoogle Scholar
  • 256. Gordon SM, Serkey JM, Longworth DL, Lytle BW, Cosgrove DMEarly onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992–1997.Ann Thorac Surg. 2000; 69:1388–92.CrossrefMedlineGoogle Scholar
  • 257. Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left-sided native valve endocarditis in adults: risk classification for mortality.JAMA. 2003; 289:1933–40.CrossrefMedlineGoogle Scholar
  • 258. Jault F, Gandjbakhch I, Rama A, et al. Active native valve endocarditis: determinants of operative death and late mortality.Ann Thorac Surg. 1997; 63:1737–41.CrossrefMedlineGoogle Scholar
  • 259. Kiefer T, Park L, Tribouilloy C, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.JAMA. 2011; 306:2239–47.CrossrefMedlineGoogle Scholar
  • 260. Tornos P, Sanz E, Permanyer-Miralda G, Almirante B, Planes AM, Soler-Soler J. Late prosthetic valve endocarditis. Immediate and long-term prognosis.Chest. 1992; 101:37–41.CrossrefMedlineGoogle Scholar
  • 261. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis.JAMA. 2007; 297:1354–61.CrossrefMedlineGoogle Scholar
  • 262. Aksoy O, Sexton DJ, Wang A, et al. Early surgery in patients with infective endocarditis: a propensity score analysis.Clin Infect Dis. 2007; 44:364–72.CrossrefMedlineGoogle Scholar
  • 263. Chirouze C, Cabell CH, Fowler VG, et al. Prognostic factors in 61 cases of Staphylococcus aureus prosthetic valve infective endocarditis from the International Collaboration on Endocarditis merged database.Clin Infect Dis. 2004; 38:1323–7.CrossrefMedlineGoogle Scholar
  • 264. Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W. Fungal endocarditis: evidence in the world literature, 1965–1995.Clin Infect Dis. 2001; 32:50–62.CrossrefMedlineGoogle Scholar
  • 265. Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study.Eur Heart J. 2007; 28:196–203.CrossrefMedlineGoogle Scholar
  • 266. Melgar GR, Nasser RM, Gordon SM, Lytle BW, Keys TF, Longworth DL. Fungal prosthetic valve endocarditis in 16 patients. An 11-year experience in a tertiary care hospital.Medicine (Baltimore). 1997; 76:94–103.CrossrefMedlineGoogle Scholar
  • 267. Remadi JP, Habib G, Nadji G, et al. Predictors of death and impact of surgery in Staphylococcus aureus infective endocarditis.Ann Thorac Surg. 2007; 83:1295–302.CrossrefMedlineGoogle Scholar
  • 268. Wolff M, Witchitz S, Chastang C, Regnier B, Vachon F. Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision.Chest. 1995; 108:688–94.CrossrefMedlineGoogle Scholar
  • 269. Anguera I, Miro JM, Vilacosta I, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality.Eur Heart J. 2005; 26:288–97.CrossrefMedlineGoogle Scholar
  • 270. Chan KL. Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess.CMAJ. 2002; 167:19–24.MedlineGoogle Scholar
  • 271. Jault F, Gandjbakhch I, Chastre JC, et al. Prosthetic valve endocarditis with ring abscesses. Surgical management and long-term results.J Thorac Cardiovasc Surg. 1993; 105:1106–13.CrossrefMedlineGoogle Scholar
  • 272. Middlemost S, Wisenbaugh T, Meyerowitz C, et al. A case for early surgery in native left-sided endocarditis complicated by heart failure: results in 203 patients.J Am Coll Cardiol. 1991; 18:663–7.CrossrefMedlineGoogle Scholar
  • 273. Wang K, Gobel F, Gleason DF, Edwards JE. Complete heart block complicating bacterial endocarditis.Circulation. 1972; 46:939–47.LinkGoogle Scholar
  • 274. Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study.Am Heart J. 2007; 154:923–8.CrossrefMedlineGoogle Scholar
  • 275. Klieverik LMA, Yacoub MH, Edwards S, et al. Surgical treatment of active native aortic valve endocarditis with allografts and mechanical prostheses.Ann Thorac Surg. 2009; 88:1814–21.CrossrefMedlineGoogle Scholar
  • 276. Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis.Ann Thorac Surg. 2012; 93:489–93.CrossrefMedlineGoogle Scholar
  • 277. Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices.JAMA. 2012; 307:1727–35.CrossrefMedlineGoogle Scholar
  • 278. Ho HH, Siu CW, Yiu KH, Tse HF, Chui WH, Chow WH. Prosthetic valve endocarditis in a multicenter registry of Chinese patients.Asian Cardiovasc Thorac Ann. 2010; 18:430–4.CrossrefMedlineGoogle Scholar
  • 279. Rundström H, Kennergren C, Andersson R, Alestig K, Hogevik H. Pacemaker endocarditis during 18 years in Göteborg.Scand J Infect Dis. 2004; 36:674–9.CrossrefMedlineGoogle Scholar
  • 280. Sohail MR, Uslan DZ, Khan AH, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection.Mayo Clin Proc. 2008; 83:46–53.CrossrefMedlineGoogle Scholar
  • 281. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis.N Engl J Med. 2012; 366:2466–73.CrossrefMedlineGoogle Scholar
  • 282. Mügge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach.J Am Coll Cardiol. 1989; 14:631–8.CrossrefMedlineGoogle Scholar
  • 283. Thuny F, Di Salvo G, Belliard O, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study.Circulation. 2005; 112:69–75.LinkGoogle Scholar
  • 284. Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan.J Thorac Cardiovasc Surg. 1995; 110:1745–55.CrossrefMedlineGoogle Scholar
  • 285. Barsic B, Dickerman S, Krajinovic V, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.Clin Infect Dis. 2013; 56:209–17.CrossrefMedlineGoogle Scholar
  • 286. García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study.Circulation. 2013; 127:2272–84.LinkGoogle Scholar
Appendix 1.

Author Relationships With Industry and Other Entities (Relevant)—2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (January 2016)

Committee MemberEmploymentConsultantSpeakers BureauOwnership/Partnership/PrincipalPersonal ResearchInstitutional, Organizational, or Other Financial BenefitExpert WitnessVoting Recusals by Section*
Rick A. Nishimura, Co-ChairMayo Clinic, Division of Cardiovascular Disease—Judd and Mary Morris Leighton Professor of MedicineNoneNoneNoneNoneNoneNoneNone
Catherine M. Otto, Co-ChairUniversity of Washington Division of Cardiology—Professor of MedicineNoneNoneNoneNoneNoneNoneNone
Robert O. BonowNorthwestern University Feinberg School of Medicine—Goldberg Distinguished Professor of CardiologyNoneNoneNoneNoneNoneNoneNone
Blase A. CarabelloEast Carolina University, Brody School of Medicine, East Carolina Heart Institute—Chief Cardiology DirectorNoneNoneNone• Edwards Lifesciences (DSMB)• Medtronic3.2.4, 7.3.3, 7.4.3, and 11.1.
John P. Erwin IIITexas A&M College of Medicine, Baylor Scott and White Health—Senior Staff Cardiologist, Clinical Professor and Chair of Internal MedicineNoneNoneNoneNoneNoneNoneNone
Lee A. FleisherUniversity of Pennsylvania, Department of Anesthesiology—Professor of AnesthesiologyNoneNoneNoneNoneNoneNoneNone
Hani JneidBaylor College of Medicine—Associate Professor of Medicine, Director of Interventional Cardiology Research; The Michael E. DeBakey VA Medical Center—Director of Interventional CardiologyNoneNoneNoneNoneNoneNoneNone
Michael J. MackThe Heart Hospital Baylor Plano—DirectorNoneNoneNoneNone• Abbott Vascular• Edwards LifesciencesNone3.2.4, 7.3.3, 7.4.3, and 11.1
Christopher J. McLeodMayo Clinic, Division of Cardiovascular Disease—Assistant Professor of MedicineNoneNoneNoneNoneNoneNoneNone
Patrick T. O’GaraBrigham and Women’s Hospital—Professor of Medicine; Harvard Medical School—Director of Clinical CardiologyNoneNoneNoneNoneNoneNone
Vera H. RigolinNorthwestern University Feinberg School of Medicine—Professor of Medicine; Northwestern Memorial Hospital—Medical Director, Echocardiography LaboratoryNoneNoneNone• PfizerNoneNoneNone
Thoralf M. Sundt IIIMassachusetts General Hospital—Chief, Division of Cardiac Surgery, Harvard Medical School—Professor of SurgeryNoneNoneNone• Edwards LifeScience—Partner trial (PI)• Medtronic—Perigon trial (PI)• Thrasos (Steering Committee)None3.2.4, 7.3.3, 7.4.3, and 11.1.
Annemarie ThompsonDuke University Medical Center—Department of Anesthesiology, Professor of Anesthesiology; Residency Program DirectorNoneNoneNoneNoneNoneNoneNone

This table represents relationships of committee members with industry and other entities that were determined to be relevant to this document. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of ≥5% of the voting stock or share of the business entity, or ownership of ≥$5000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Relationships that existwith no financial benefit are also included for the purpose of transparency. Relationships in this table aremodest unless otherwise noted. According to the ACC/AHA, a person has a relevant relationship IF: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) the company/entity (with whomthe relationship exists)makes a drug, drug class, or device addressed in the document ormakes a competing drug or device addressed in the document; or c) the person or a member of the person’s household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.

*Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply. Section numbers pertain to those in the full-text guideline.

No financial benefit.

Significant relationship.

ACC indicates American College of Cardiology; AHA, American Heart Association; Partner, Placement of Aortic Transcatheter Valve; Perigon, Pericardial Surgical Aortic Valve Replacement; and VA, Veterans Affairs.

Appendix 2.

Reviewer Relationships With Industry and Other Entities (Comprehensive)—2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (September 2016)

ReviewerRepresentationEmploymentConsultantSpeakers BureauOwnership/Partnership/PrincipalPersonal ResearchInstitutional, Organizational, or Other Financial BenefitExpert Witness
Salvatore P. CostaOfficial Reviewer—AHADartmouth-Hitchcock Medical Center; Section of CardiologyNoneNoneNoneNoneNoneNone
Federico GentileOfficial Reviewer—ACC/AHA Task Force on Clinical Practice Guidelines Lead ReviewerCentro Medico Diagnostico—Director, Cardiovascular DiseaseNoneNoneNoneNoneNoneNone
Lawrence G. RudskiOfficial Reviewer—ACC Board of GovernorsJewish General Hospital, McGill University—Professor of Medicine; Integrated Cardiovascular Sciences Program—DirectorNoneNone• Medtronic*• Sanofi/Genzyme*• GE Healthcare*• CSENone
John J. RyanOfficial Reviewer—AHAUniversity of Utah Health Sciences Center—Division of Cardiovascular MedicineNoneNoneNoneNone• NovartisNone
David AdamsOrganizational Reviewer—AATSMount Sinai Medical Center; Department of Cardiovascular Surgery—Professor and System ChairNoneNoneNone• Medtronic• NeoChord• Edwards Lifesciences*• Medtronic*None
Joseph E. BavariaOrganizational Reviewer—STSHospital of the University of Pennsylvania; Division of Cardiovascular Surgery—Vice Chief; Thoracic Aortic Surgery Program—Director; Transcatheter Valve Program—Co-DirectorNoneNoneNone• CyotoSorbents• Edwards Lifesciences• Medtronic• St. Jude Medical• Vascutek• W.L. Gore• Edwards Lifesciences• MedtronicNone
Wael A. JaberOrganizational Reviewer—ASECleveland Clinic Foundation, Cardiovascular Medicine, Cardiovascular Imaging Core Laboratory—DirectorNoneNoneNone• Edwards LifesciencesNoneNone
Stanton ShernanOrganizational Reviewer—SCABrigham and Women’s Hospital, Cardiac Anesthesia Division—Director; Harvard Medical School—ProfessorNoneNoneNoneNone• Philips Healthcare• National Board of EchocardiographyNone
Molly SzerlipOrganizational Reviewer—SCAIThe Heart Group—Interventional Cardiologist; The Heart Hospital Baylor Plano—Medical Director, Inpatient and Outpatient Valve Program• Edwards Lifesciences• Medtronic• Abiomed• Edwards LifesciencesNoneNone• Edwards Lifesciences• MedtronicNone
Kim K. BirtcherContent Reviewer—ACC/AHA Task Force on Clinical Practice GuidelinesUniversity of Houston College of Pharmacy—Clinical Professor• Jones & Bartlett• LearningNoneNoneNoneNoneNone
Vera BittnerContent Reviewer—ACC Prevention of Cardiovascular Disease Section Leadership CouncilUniversity of Alabama at Birmingham—Professor of Medicine; Section Head, General Cardiology, Prevention and Imaging• Eli Lilly• ABIM*• Alabama ACC• Alabama ACPNoneNone• Amgen• AstraZeneca*• Bayer Healthcare*• DalCor*• Pfizer• Sanofi-aventis*• National Lipid AssociationNone
Emmanouil BrilakisContent ReviewerLaboratory, VA North Texas Healthcare System—Director Cardiac Catheterization• Abbott Vascular*• Asahi• Cardinal Health• Elsevier• GE Healthcare• St. Jude MedicalNoneNone• Boston Scientific*• InfraRedx*• Abbott Vascular• AstraZeneca• Cerenis Therapeutics*• Cordis*• Daiichi Sankyo*• Guerbet*• InfraRedx*• SCAINone
James FangContent ReviewerUniversity of Utah School of Medicine—Chief of Cardiovascular Medicine; University of Utah Health Care—Director, Cardiovascular Service Line• AccordiaNoneNone• Actelion (DSMB)• Cardiocell (DSMB)• NIH (DSMB• CardioKinetix• NIH• NovartisNone
Michael S. FirstenbergContent Reviewer—ACC Surgeons’ CouncilThe Summa Health System—Thoracic and Cardiac Surgery• Allmed*• Johnson & Johnson• Maquet Cardiovascular*NoneNoneNone• GrisfolsNone
Annetine GelijnsContent ReviewerMount Sinai Medical Center, Population Health Science and Policy—Professor and System ChairNoneNoneNoneNone• Icahn School of Medicine at Mount Sinai*• NIHNone
Samuel GiddingContent Reviewer—ACC/AHA Task Force on Clinical Practice GuidelinesNemours/Alfred I. duPont Hospital for Children—Chief, Division of Pediatric Cardiology• FH Foundation• International FH FoundationNoneNone• FH Foundation• NIH*NoneNone
Paul A. GrayburnContent ReviewerBaylor Heart and Vascular Institute—Director of Cardiology Research• Abbott Vascular*• TendyneNoneNone• Abbott Vascular• Boston Scientific• Medtronic• Tendyne• Valtech Cardio• American Journal of Cardiology• NeoChordNone
Richard GrimmContent Reviewer—ACC Heart Failure and Transplant Section Leadership CouncilCleveland Clinic Foundation, Department of Cardiovascular Medicine—Medical Director of Echo Lab• Abbott LaboratoriesNoneNoneNoneNoneNone
Jonathan L. HalperinContent Reviewer—ACC/AHA Task Force on Clinical Practice GuidelinesMount Sinai Medical Center—Professor of Medicine• AstraZeneca• Bayer• Boston ScientificNoneNoneNoneNoneNone
Alex IribarneContent Reviewer—ACC Surgeons’ CouncilDartmouth Hitchcock Medical Center—Attending Cardiac Surgeon; Cardiac Surgical Research—Director; The Dartmouth Institute—Assistant Professor of SurgeryNoneNoneNoneNoneNoneNone
Craig JanuaryContent ReviewerUniversity of Wisconsin-Madison—Professor of Medicine, Cardiovascular Medicine DivisionNoneNoneNoneNoneNoneNone
José JoglarContent Reviewer—ACC/AHA Task Force on Clinical Practice GuidelinesUT Southwestern Medical Center—Associate Professor of Internal MedicineNoneNoneNoneNone• Medtronic*• St. Jude Medical*None
Kyle W. KlarichContent ReviewerMayo Clinic—Professor of MedicineNoneNoneNoneNoneNoneNone
Gautam KumarContent Reviewer—ACC Interventional Section Leadership CouncilEmory University, Division of Cardiology—Assistant Professor of Medicine• Abiomed• CSI Medical• T3 Labs• Trireme MedicalNoneNoneNone• Orbus-Neich Medical• Osprey Medical• StentysNone
Richard LangeContent ReviewerContent Reviewer Texas Tech University Health Sciences Center at El Paso—PresidentNoneNoneNoneNoneNoneNone
Susan T. LaingContent Reviewer—ACC Heart Failure and Transplant Section Leadership CouncilUT Health Science Center at Houston (UT Health)—Professor of Medicine, Division of Cardiology, Associate Chief; Director of EchocardiographyNoneNoneNoneNoneNoneNone
Glenn LevineContent Reviewer—ACC/AHA Task Force on Clinical Practice GuidelinesBaylor College of Medicine—Professor of Medicine; Director, Cardiac Care UnitNoneNoneNoneNoneNone• Defendant, Hospital Death, 2016• Defendant, Catheterization Laboratory Procedure, 2016
Brian LindmanContent ReviewerWashington University School of Medicine in St. Louis, Cardiovascular Division—Associate Professor of Medicine• Roche DiagnosticsNoneNone• AHA Clinical Research Grant*• Barnes-Jewish Hospital Foundation*• Doris Duke Charitable Foundation*• Edwards Lifesciences*• NIH• Roche• Diagnostics*• NIH*None
D. Craig MillerContent ReviewerStanford University Medical Center—Cardiothoracic Surgeon• Medtronic• NHLBINoneNone• Abbott Laboratories• Edwards Lifesciences• MedtronicNoneNone
Stefano NistriContent ReviewerCMSR Veneto Medica—Chief, Cardiology ServiceNoneNoneNoneNoneNoneNone
Philippe PibarotContent ReviewerUniversité Laval—Professor of Medicine; Canada Research in Valvular Heart DiseasesNoneNoneNone• Cardiac Phoenix*• Edwards Lifesciences*• Medtronic*• V-Wave*• Canadian Institute of HealthNoneNone
Hartzell V. SchaffContent ReviewerMayo Clinic—Professor of SurgeryNoneNoneNoneNoneNoneNone
Allan SchwartzContent ReviewerColumbia University Medical Center—Chief, Division of Cardiology, Vice Chair of Department of MedicineNoneNoneNoneNoneNoneNone
Karen StoutContent ReviewerUniversity of Washington—Director, Adult Congenital Heart Disease Program, Professor, Internal Medicine and PediatricsNoneNoneNoneNoneNoneNone
Rakesh SuriContent ReviewerCleveland Clinic Foundation—Professor of Surgery, Department of Thoracic and Cardiovascular Surgery• Sorin AbbottNoneNone• St. Jude Medical• St. Jude MedicalNone
Vinod ThouraniContent ReviewerEmory University School of Medicine, Division of Cardiothoracic Surgery— Professor of Surgery; Structural Heart and Valve Center of the Emory Heart and Vascular Center—Co-Director; Emory University Hospital Midtown—Chief of Cardiothoracic Surgery• Edwards Lifesciences• St. Jude MedicalNoneNone• Abbott Medical• Boston Scientific• Edwards Lifesciences• MedtronicNoneNone
E. Murat TuzcuContent ReviewerCleveland Clinic Abu Dhabi—Cardiovascular MedicineNoneNoneNoneNone• Boston Scientific• Direct Flow Medical• St. Jude Medical• TendyneNone
Andrew WangContent ReviewerDuke University Medical Center—Professor of Medicine; Cardiovascular Disease Fellowship Program—Director• Heart Metabolics*• ACP*NoneNoneNone• Abbott Vascular*• Gilead Sciences*• Maokardia*• Edwards Lifesciences• MedtronicNone
L. Samuel WannContent ReviewerColumbia St. Mary’s Cardiovascular Physicians—Clinical Cardiologist• United HealthcareNoneNoneNoneNoneNone
Frederick WeltContent Reviewer—ACC Interventional Section Leadership CouncilUniversity of Utah Health Sciences Center, Division of Cardiology—Director, Interventional Cardiology• MedtronicNoneNoneNone• Athersys• Capricor• CardioKinetix• Medtronic• Renova Therapeutics• Siemens• Teva Pharmaceuticals• Washington UniversityNone

This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review, including those not deemed to be relevant to this document, at the time this document was under review. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of ≥5% of the voting stock or share of the business entity, or ownership of ≥$5000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Relationships that exist with no financial benefit are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted. Names are listed in alphabetical order within each category of review. Please refer to http://www.acc.org/guidelines/about-guidelines-and-clinical-documents/relationships-with-industry-policy for definitions of disclosure categories or additional information about the ACC/AHA Disclosure Policy for Writing Committees.

*Significant relationship.

No financial benefit.

AAFP indicates American Academy of Family Physicians; AATS, American Association for Thoracic Surgery; ABIM, American Board of Internal Medicine; ACC, American College of Cardiology; ACP, American College of Physicians; AHA, American Heart Association; ASE, American Society of Echocardiography; CSE, Canadian Society of Echocardiography; DSMB, data safety monitoring board; FH, familial hyperlipidemia; NHLBI, National Heart, Lung, and Blood Institute; NIH, National Institutes of Health; SCAI, Society for Cardiovascular Angiography and Interventions; SCA, Society of Cardiovascular Anesthesiologists; STS, Society of Thoracic Surgeons; UT, University of Texas; and WVU, West Virginia University.

Appendix 3.

Abbreviations

AF = atrial fibrillation
AS = aortic stenosis
AVR = aortic valve replacement
CABG = coronary artery bypass graft surgery
CI = confidence interval
CT = computed tomography
DOACs = direct oral anticoagulants
EF = ejection fraction
GDMT = guideline-directed management and therapy
HF = heart failure
HR= hazard ratio
IE = infective endocarditis
INR = International Normalized Ratio
LV = left ventricular
LVEF = left ventricular ejection fraction
LVESD = left ventricular end-systolic diameter
MR = mitral regurgitation
MS = mitral stenosis
MVR = mitral valve replacement
NYHA = New York Heart Association
RCT = randomized controlled trial
TAVR = transcatheter aortic valve replacement
VHD = valvular heart disease
VKA = vitamin K antagonist

eLetters(0)

eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.

Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.