ESC Congress 2017 In Review -- Main Edition - 10

Main Session

Refer to Table 10 for aspects to be considered by the
Heart Team for the decision between SAVR and TAVI in
patients at increased surgical risk.

Table 11 summarises changes in the 2017 VHD guidelines regarding primary and secondary mitral regurgitation.

Table 10. Aspects to Be Considered by the Heart Team for the Decision
Between SAVR And TAVI in Patients at Increased Surgical Risk

Table 11. Changes in the 2017 Valvular Heart Disease Recommendations

Favours
TAVI

Favours
SAVR

Clinical characteristics
+

STS/EuroSCORE II ≥ 4% (logistic EuroSCORE I ≥ 10%)

+

Presence of severe comorbidity (not adequately
reflected by scores)

+

Age < 75 years

+

Age ≥ 75 years

+

Previous cardiac surgery

+

Frailty

+

Restricted mobility and conditions that may affect
the rehabilitation process after the procedure

+

Suspicion of endocarditis

+

Unfavourable access (any) for TAVI

+

Sequelae of chest radiation

+

Porcelain aorta

+

Presence of intact coronary bypass grafts at risk
when sternotomy is performed

+

Expected patient-prosthesis mismatch

+

Short distance between coronary ostia and aortic
valve annulus

+

Size of aortic valve annulus out of range for TAVI

+

Aortic root morphology unfavourable for TAVI

+

Valve morphology (bicuspid, degree of calcification,
calcification pattern) unfavourable for TAVI

+

Presence of thrombi in aorta or LV

+

Cardiac conditions in addition to aortic stenosis that require consideration
for concomitant intervention
Severe CAD requiring revascularisation by CABG

+

Severe primary mitral valve disease, which could be
treated surgically

+

Severe tricuspid valve disease

+

Aneurysm of the ascending aorta

+

Septal hypertrophy requiring myectomy

+

CABG, coronary artery bypass surgery; CAD, coronary artery disease; LV, left
ventricular; SAVR, surgical aortic valve replacement; STS, Society of Thoracic
Surgery; TAVI, transcatheter aortic valve implantation.

October 2017

2017

IIb C Surgery may be considered
in asymptomatic patients with preserved LV function, high likelihood of
durable repair, low surgical risk, and:
*	 Left	atrial	dilatation	(volume	index	
≥ 60 mL/m2 BSA) and sinus rhythm.

IIa C Surgery should be considered
in asymptomatic patients with
preserved LVEF (> 60%) and LVESD
40-44 mm when a durable repair is
likely, surgical risk is low, the repair
is performed in heart valve centres,
and the following finding is present:
presence of significant LA dilatation
(volume index ≥ 60 mL/m2 BSA) in
sinus rhythm.

Pulmonary hypertension on exercise
(SPAP ≥ 60 mm Hg at exercise.

Recommendation removed

Indications for mitral valve intervention in secondary mitral regurgitation
+

Anatomical and technical aspects

10

2012

Indications for intervention in symptomatic aortic stenosis

STS/EuroSCORE II < 4% (logistic EuroSCORE I < 10%)

Favourable access for transfemoral TAVI

Changes in Recommendations

IIa C Surgery should be considered
in patients with moderate secondary
mitral regurgitation undergoing CABG.

Recommendation removed

IIb C When revascularisation is not
indicated, surgery may be considered
in patients with severe secondary
mitral regurgitation and LVEF > 30%,
who remain

IIb C When revascularisation is not
indicated, surgery may be considered
in patients with severe secondary mitral regurgitation and LVEF
> 30%, who remain symptomatic
despite optimal medical management
(including CRT if indicated), and have
a low surgical risk.
IIb C When revascularisation is not
indicated and surgical risk is not low,
a percutaneous edge-to-edge
procedure may be considered in
patients with severe secondary mitral
regurgitation and LVEF > 30%, who
remain symptomatic despite optimal
medical management (including CRT
if indicated) and who have a suitable
valve morphology by
echocardiography, avoiding futility.
IIb C In patients with severe
secondary mitral regurgitation and
LVEF > 30%, who remain symptomatic
despite optimal medical management
(including CRT if indicated) and who
have no option for revascularisation,
the Heart Team may consider
percutaneous edge-to-edge procedure
or valve surgery after careful
evaluation for ventricular assist device
or heart transplant according to
individual patient characteristics.

BSA, body surface area; LA, left atrial; CABG, coronary artery bypass grafting;
CRT, cardiac resynchronisation therapy; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; SPAP, systolic pulmonary artery pressure.

www.escardio.org/ESCcongressinreview


http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2017 In Review -- Main Edition

Contents
ESC Congress 2017 In Review -- Main Edition - Cover1
ESC Congress 2017 In Review -- Main Edition - Cover2
ESC Congress 2017 In Review -- Main Edition - 1
ESC Congress 2017 In Review -- Main Edition - 2
ESC Congress 2017 In Review -- Main Edition - Contents
ESC Congress 2017 In Review -- Main Edition - 4
ESC Congress 2017 In Review -- Main Edition - 5
ESC Congress 2017 In Review -- Main Edition - 6
ESC Congress 2017 In Review -- Main Edition - 7
ESC Congress 2017 In Review -- Main Edition - 8
ESC Congress 2017 In Review -- Main Edition - 9
ESC Congress 2017 In Review -- Main Edition - 10
ESC Congress 2017 In Review -- Main Edition - 11
ESC Congress 2017 In Review -- Main Edition - 12
ESC Congress 2017 In Review -- Main Edition - 13
ESC Congress 2017 In Review -- Main Edition - 14
ESC Congress 2017 In Review -- Main Edition - 15
ESC Congress 2017 In Review -- Main Edition - 15A
ESC Congress 2017 In Review -- Main Edition - 15B
ESC Congress 2017 In Review -- Main Edition - 15C
ESC Congress 2017 In Review -- Main Edition - 15D
ESC Congress 2017 In Review -- Main Edition - 16
ESC Congress 2017 In Review -- Main Edition - 17
ESC Congress 2017 In Review -- Main Edition - 18
ESC Congress 2017 In Review -- Main Edition - 19
ESC Congress 2017 In Review -- Main Edition - 20
ESC Congress 2017 In Review -- Main Edition - 21
ESC Congress 2017 In Review -- Main Edition - 22
ESC Congress 2017 In Review -- Main Edition - 23
ESC Congress 2017 In Review -- Main Edition - 24
ESC Congress 2017 In Review -- Main Edition - 25
ESC Congress 2017 In Review -- Main Edition - 26
ESC Congress 2017 In Review -- Main Edition - 27
ESC Congress 2017 In Review -- Main Edition - 28
ESC Congress 2017 In Review -- Main Edition - 29
ESC Congress 2017 In Review -- Main Edition - 30
ESC Congress 2017 In Review -- Main Edition - 31
ESC Congress 2017 In Review -- Main Edition - 32
ESC Congress 2017 In Review -- Main Edition - Cover3
ESC Congress 2017 In Review -- Main Edition - Cover4
http://www.nxtbookMEDIA.com