Early Surgery in Valvular Heart Disease

Abstract

The burden of valvular heart disease (VHD) is increasing with age, and the elderly patients with moderate or severe VHD are notably common. When to operate in asymptomatic patients with VHD remains controversial. The controversy is whether early surgical intervention should be preferred, or a watchful waiting approach should be followed. The beneficial effects of early surgery should be balanced against operative mortality and long-term results. Indications of early surgery in each of the VHD will be discussed in this review on the basis of the latest American and European guidelines.

Keywords: Aortic valve insufficiency; Aortic valve stenosis; Cardiac surgical procedures; Endocarditis; Mitral valve insufficiency.

Figure 1. Early surgical indications for asymptomatic patients with severe MR. Adapted from ACC/AHA 2014/2017 and ESC/ECTS 2017 guidelines. Following the arrows according to the decision pathways leads to a recommendation for MV surgery.

ACC/AHA = American College of Cardiology/American Heart Association; AF = atrial fibrillation; EF = ejection fraction; ESC/ECTS = European Society of Cardiology/European Credit Transfer System; LVESD = left ventricular end-systolic dimension; LA = left atrium; MR = mitral regurgitation; MV = mitral valve; PHT = pulmonary hypertension.

Figure 2. Indications for early surgery in patients with asymptomatic severe AS. Adapted from ACC/AHA 2014/2017 and ESC/ECTS 2017 guidelines.

ACC/AHA = American College of Cardiology/American Heart Association; AS = aortic stenosis; AVR = aortic valve replacement; BP = blood pressure; BNP = brain natriuretic peptide; CABG = coronary artery bypass graft; ESC/ECTS = European Society of Cardiology/European Credit Transfer System; LVEF = left ventricular ejection fraction; STS PROM = society of thoracic surgery predicted risk of mortality; PHT = pulmonary hypertension.

Figure 3. Indications for early surgery in patients with left-sided IE. Early surgery is performed during initial hospitalization before completion of a full therapeutic course of antibiotics. Adapted from ACC/AHA 2014 and ESC 2015 guidelines.

ACC/AHA = American College of Cardiology/American Heart Association; ESC = European Society of Cardiology; HF = heart failure; IE = infective endocarditis; OP = operative.