瓣膜病的手术时机选择
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瓣膜病的手术时机选择
Fighting CVD
Indications for Aortic Valve Replacement in pts with AS
Class I 1. AVR is indicated for symptomatic patients with severe
AS (LOE: B)
Indications for Aortic Valve Replacement in pts with AS
Class IIb
3. AVR may be considered in pts undergoing CABG who have mild AS when there is evidence, such as moderate to severe valve calcification, that progression may be rapid. (LOE: C)
4. AVR may be considered for asymptomatic pts with extremely severe AS (AVA 0.6 cm2 , MPG 60 mm Hg, and jet velocity 5.0m/sec) when the patient’s expected operative mortality is 1.0% (LOE: C)
4. AVR is recommended for patients with severe AS and LV systolic dysfunction (EF 0.50). (LOE: C)
Class IIa • AVR is reasonable for pts with moderate AS undergoing
Indications for Aortic Valve Replacement in pts with AS
Class III
• AVR is not useful for the prevention of sudden death in asymptomatic patients with AS who have none of the findings listed under the class IIa/IIb recommendations. (LOE: B)
Severe Aortic Stenosis
Vmax greater than 4 m/s AVA less than 1.0 cm2
Mean gradient ＞ 40 mmHg
Undergoing CABG or other heart sur百度文库ery?
Symptoms?
Re- evaluation
CABG or surgery on the aorta or other heart valves (LOE: B)
Indications for Aortic Valve Replacement in pts with AS
Class IIb
1. AVR may be considered for asymptomatic pts with severe AS and abnormal response to exercise (e.g., development of symptoms or asymptomatic hypotension). (LOE: C)
Indications for Aortic Valve Replacement in pts with AR
Class I 1. AVR is indicated for symptomatic pts with severe AR
irrespective of LV systolic function. (LOE: B)
Yes
Equivocal
No
Normal
Exercise test
Symptoms ↓BP
Less than 0.50
LV ejection fraction
Normal
Yes
Class Ⅰ Class Ⅰ Class Ⅱb Class Ⅰ Class Ⅱb
Aortic Valve Replacement Preoperative coronary angiography
2. AVR is indicated for patients with severe AS undergoing CABG (LOE: C)
3. AVR is indicated for patients with severe AS undergoing surgery on the aorta or other heart valves. (LOE: C)
2. AVR may be considered for adults with severe asymptomatic AS if there is a high likelihood of rapid progression (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset. (LOE: C)
2. AVR is indicated for asymptomatic pts with chronic severe AR and LV systolic dysfunction (EF 0.50) at rest. (LOE:B)
3. AVR is indicated for pts with chronic severe AR while undergoing CABG or surgery on the aorta or other heart valves. (LOE: C)
Severe valve calcification, rapid progression, and/or expected delays in surgery
No
Clinical follow-up, patient education, risk factor
modification, annual echo
Fighting CVD
Indications for Aortic Valve Replacement in pts with AS
Class I 1. AVR is indicated for symptomatic patients with severe
AS (LOE: B)
Indications for Aortic Valve Replacement in pts with AS
Class IIb
3. AVR may be considered in pts undergoing CABG who have mild AS when there is evidence, such as moderate to severe valve calcification, that progression may be rapid. (LOE: C)
4. AVR may be considered for asymptomatic pts with extremely severe AS (AVA 0.6 cm2 , MPG 60 mm Hg, and jet velocity 5.0m/sec) when the patient’s expected operative mortality is 1.0% (LOE: C)
4. AVR is recommended for patients with severe AS and LV systolic dysfunction (EF 0.50). (LOE: C)
Class IIa • AVR is reasonable for pts with moderate AS undergoing
Indications for Aortic Valve Replacement in pts with AS
Class III
• AVR is not useful for the prevention of sudden death in asymptomatic patients with AS who have none of the findings listed under the class IIa/IIb recommendations. (LOE: B)
Severe Aortic Stenosis
Vmax greater than 4 m/s AVA less than 1.0 cm2
Mean gradient ＞ 40 mmHg
Undergoing CABG or other heart sur百度文库ery?
Symptoms?
Re- evaluation
CABG or surgery on the aorta or other heart valves (LOE: B)
Indications for Aortic Valve Replacement in pts with AS
Class IIb
1. AVR may be considered for asymptomatic pts with severe AS and abnormal response to exercise (e.g., development of symptoms or asymptomatic hypotension). (LOE: C)
Indications for Aortic Valve Replacement in pts with AR
Class I 1. AVR is indicated for symptomatic pts with severe AR
irrespective of LV systolic function. (LOE: B)
Yes
Equivocal
No
Normal
Exercise test
Symptoms ↓BP
Less than 0.50
LV ejection fraction
Normal
Yes
Class Ⅰ Class Ⅰ Class Ⅱb Class Ⅰ Class Ⅱb
Aortic Valve Replacement Preoperative coronary angiography
2. AVR is indicated for patients with severe AS undergoing CABG (LOE: C)
3. AVR is indicated for patients with severe AS undergoing surgery on the aorta or other heart valves. (LOE: C)
2. AVR may be considered for adults with severe asymptomatic AS if there is a high likelihood of rapid progression (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset. (LOE: C)
2. AVR is indicated for asymptomatic pts with chronic severe AR and LV systolic dysfunction (EF 0.50) at rest. (LOE:B)
3. AVR is indicated for pts with chronic severe AR while undergoing CABG or surgery on the aorta or other heart valves. (LOE: C)
Severe valve calcification, rapid progression, and/or expected delays in surgery
No
Clinical follow-up, patient education, risk factor
modification, annual echo