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Multiple valve disease — Clinical Guidelines

Overview

Multiple valve disease encompasses conditions affecting more than one heart valve, often requiring comprehensive management strategies including surgical and transcatheter interventions. Participation in cardiac rehabilitation post-AVR varies significantly between TAVR and SAVR, highlighting the need for tailored approaches 1.

Diagnosis

Echocardiography for valve structure and function assessment 1 3.

Cardiac catheterization may be necessary for detailed hemodynamic evaluation 1 3.

Hemodynamic parameters and clinical symptoms guide grading severity 1 3.

Management

Surgical Aortic Valve Replacement (SAVR): Standard approach for multiple valve disease, particularly when multiple valves are involved 1 2.

Transcatheter Aortic Valve Replacement (TAVR): Increasingly used, especially in high-risk patients, though participation in cardiac rehabilitation post-TAVR is lower compared to SAVR 1 2.

Minimally Invasive Approaches: Experience, whether institutional or individual, significantly impacts outcomes; sutureless valves may enhance feasibility 2.

Multidisciplinary Heart Teams: Essential for optimal patient management, integrating cardiologists and cardiac surgeons 3.

Special Populations

Comorbidities: No specific details provided in abstracts regarding unique management in comorbidities 1 2 3.

Pregnancy: Not addressed in provided abstracts 1 2 3.

Pediatrics: Not addressed in provided abstracts 1 2 3.

Elderly: TAVR is increasingly favored in elderly patients due to lower invasiveness 1 2.

Key Recommendations

Implement cardiac rehabilitation programs post-AVR, with higher emphasis on SAVR patients to improve outcomes (Evidence: Moderate 1).

Utilize multidisciplinary heart teams comprising cardiologists and cardiac surgeons for comprehensive management of multiple valve disease (Evidence: Expert opinion 3).

Consider patient-specific factors, including institutional and individual surgical experience, when choosing between TAVR and SAVR (Evidence: Moderate 2).

References

1 Guduguntla V, Yaser JM, Keteyian SJ, Pagani FD, Likosky DS, Sukul D et al.. Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care. Circulation. Cardiovascular quality and outcomes 2022. link 2 Hawkins RB, Ailawadi G. Institutional or individual experience matters in minimally invasive valve surgery. The Journal of thoracic and cardiovascular surgery 2016. link 3 Colombo A, Ruparelia N. Transcatheter valve interventions: playground for cardiologists or cardiac surgeons? The cardiologist's view. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2015. link 4 . Valve disease and pulmonary arterial hypertension due to appetite suppressants (update). Prescrire international 2000. link

Multiple valve disease