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
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