2017 Update to the AHA/ACC Guideline for Management of ...

[Pages:30]2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease

Patrick T. O'Gara, MD

BWH Heart and Vascular Center Professor of Medicine, Harvard Medical School

Disclosures

? NHLBI CTSN Co-chair ? Medtronic Apollo Exec Cmte

2017 Valvular Heart Disease Guideline Writing Committee

Rick A. Nishimura, MD, MACC, FAHA, Co-Chair Catherine M. Otto, MD, FACC, FAHA, Co-Chair

Robert O. Bonow, MD, MACC, FAHA Michael J. Mack, MD, FACC*

Blase A. Carabello, MD, FACC*

Christopher J. McLeod, MBChB, PhD, FACC, FAHA

John P. Erwin III, MD, FACC, FAHA Patrick T. O'Gara, MD, MACC, FAHA

Lee A. Fleisher, MD, FACC, FAHA

Vera H. Rigolin, MD, FACC?

Hani Jneid, MD, FACC, FAHA, FSCAI? Thoralf M. Sundt III, MD, FACC#

Annemarie Thompson, MD**

*Focused Update writing group members are required to recuse themselves from voting on sections to which their

specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ?SCAI Representative. STS Representative.

?ASE Representative. #AATS Representative. **SCA Representative..

The MV Apparatus

? Leaflets ? Annulus ? [LA endocardium] ? Chordae tendineae ? Papillary muscles, LV

Otto CM. NEJM 2001; 345:740

Chronic Mitral Regurgitation

Etiology

Primary ? Myxomatous ? Endocarditis ? MAC, RHD, XRT ? Other

Secondary ? Ischemic ? DCM ? HOCM* ? Other

Leaflet/Chordal Disease

Ventricular Disease

Question 1

Which of the following anti-thrombotic strategies can reasonably be employed for patients with AF and native VHD other than moderate or severe rheumatic MS?

1.ASA 81 mg daily + clopidogrel 75 mg daily 2.Rivaroxaban 30 mg daily 3.Warfarin to INR 1.5-2.0 + aspirin 81 mg daily 4.Apixaban 5 mg twice daily 5.Dabigatran 110 mg twice daily

Question 1

Which of the following anti-thrombotic strategies can reasonably be employed for patients with AF and native VHD other than moderate or severe rheumatic MS?

1.ASA 81 mg daily + clopidogrel 75 mg daily 2.Rivaroxaban 30 mg daily 3.Warfarin to INR 1.5-2.0 + aspirin 81 mg daily 4.Apixaban 5 mg twice daily 5.Dabigatran 110 mg twice daily

Anticoagulation for Atrial Fibrillation in Patients With VHD (New Section)

Recommendations New: Anticoagulation with a VKA is indicated for patients with rheumatic mitral stenosis and AF

New: Anticoagulation is indicated in patients with AF and a CHA2DS2-VASc score of 2 or greater with native aortic valve disease, tricuspid valve disease, or MR New: It is reasonable to use a DOAC as an alternative to a VKA in patients with AF and native aortic valve disease, tricuspid valve disease, or MR and a CHA2DS2-VASc score of 2 or greater

COR LOE I B-NR I C-LD

IIa C-LD

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download