ESC/EACTS vs. ACC/AHA Guidelines for Severe Aortic Stenosis: Key Points
- Lee G, Chikwe J, Milojevic M, et al.
- ESC/EACTS vs. ACC/AHA Guidelines for the Management of Severe Aortic Stenosis. Eur Heart J 2023;44:796-812.
The following are key points to remember from a state-of-the-art review that compares recommendations for severe aortic stenosis (AS) in the recent European versus American guidelines for the management of patients with valvular heart disease:
- Overview. The 2020 American College of Cardiology/American Heart Association (ACC/AHA) and the 2021 European Society of Cardiology/European Association for Cardiac and Thoracic Surgery (ESC/EACTS) guidelines for the management of heart valve disease have far more in common than they have differences in recommendations for the management of patients with severe aortic stenosis (AS).
- Differences. There are only three areas in which there are substantial differences in the recommendations:
- Asymptomatic AS with reduced left ventricular ejection fraction (LVEF). Among asymptomatic patients with severe AS in whom intervention is considered based on reduced LVEF, the ESC/EACTS guidelines use an LVEF threshold of <55% in the absence of other evident cause, whereas the ACC/AHA guidelines use an LVEF threshold of 60% in the setting of progressively decreasing EF on three serial echocardiograms.
- Tissue vs. mechanical surgical aortic valve replacement (SAVR). In the context of decision making between tissue and mechanical SAVR, and whereas both guidelines incorporate Heart Team discussion, preference of the informed patient, and contraindications to anticoagulation; ACC/AHA recommendations use age thresholds of <50 years for a mechanical valve and >65 years for a bioprosthesis and the ESC/EACTS guidelines use respective thresholds of <60 years and >65 years.
- Transcatheter aortic valve replacement (TAVR) vs. SAVR age thresholds. Both guidelines highlight patient age as a major consideration for SAVR vs. TAVR. However, the ACC/AHA guidelines use age thresholds of <65 years or life expectancy >20 years to recommend SAVR and age >80 years or life expectancy <10 years to recommend TAVR, and the ESC/EACTS guidelines use respective thresholds of age <75 years and low surgical risk for SAVR and age ≥75 years for TAVR.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Diagnostic Imaging, Echocardiography, Exercise Test, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Natriuretic Peptide, Brain, Patient Care Team, Risk Assessment, Stroke Volume, Tomography, Emission-Computed, Transcatheter Aortic Valve Replacement
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