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Contemporary Presentation and Management of Valvular Heart Disease

2019; Lippincott Williams & Wilkins; Volume: 140; Issue: 14 Linguagem: Inglês

10.1161/circulationaha.119.041080

1524-4539

J Milosavljević, L. Jovovic, Roman Margoczy, Gabriel Valočík, Martin Studenčan, Francisco Calvo, Irene Méndez, Alyana Gomez, P. L. Sánchez Fernandez, G. M. Valenzuela, M Cladellas, D.V. Villegas, Sergio Moral, Irene Menduiña Gallego, Rafael Payá, Luis Caballero, Richard R. Paton, Esther Esteban, Cristina Iglesia-Carreno, M ALBERCA, Alfonso Valle, M. J. Molina-Mora, N. Castro, Nurten Sayar, Abdullah Orhan Demirtaş, Asuman Biçer Yeşilay, S. Demir, Atilla Bozkurt, Batur Gönenç Kanar, Naile Eriş Güdül, Tarık Yıldırım, Gökay Taylan, Kadir Uğur Mert, Mustafa Adem Yılmaztepe, Gurbet Özge Mert, Kahraman Coşansu, M. R. Sayin, Turgut Karabağ, Eorp Vhd Ii Investigators, Bernard Iung, Victoria Delgado, Raphael Rosenhek, Susanna Price, Bernard Prendergast, Olaf Wendler, Michele De Bonis, Christophe Tribouilloy, Arturo Evangelista, Alexander Bogachev‐Prokophiev, Astrid Apor, Hueseyin Ince, Cécile Laroche, Luc Piérard, Michael Haude, Gerhard Hindricks, Frank Ruschitzka, Stefan Windecker, Jeroen J. Bax, Aldo P. Maggioni, Alec Vahanian, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, H. Druais, A Goda, Julia Mascherbauer, Fuad Samadov, Kateřina Linhartová, Nikolaj Ihlemann, Magdy Abdelhamid, Elizabeta Srbinovska Kostovska, Gani Bajraktari, Erkin М Мirrakhimov, David Cassar, Regina Ribeiras, Branko Beleslin, Iveta Šimková, Sait Mesut Doğan, Shelley Rahman-Haley, E Shirka, E Dado, E Zëra, Laura Bica, Maria Heger, Fargana Muslumova, T. Jahangirov, Tahir Ahmedov, S. Husseynov, Agnès Pasquet, Bernard Cosyns, Guy Van Camp, S Sindelárová, Marian Branny, Ilona Pařenicová, Dagmar Jungwirtova Vondrackova, Miroslav Homza, Jiří Ostřanský, Hosam Hasan‐Ali, Yasser Ahmed Abdelhady, Mohamed Hassan, Heba Soliman, Asma Mostafa, Mai Moaaz, Ghada Kazamel, Yahia Kamal Sadek, Sherif El‐Tobgi, D Kamal, Minna Kylmälä, Antti Saraste, Anu Turpeinen, J.-L. Monin, Yannick Jobic, David Attias, Julien Magné, Sylvestre Maréchaux, Erwan Donal, L. Biere, Anne Bernard, M. Daudin, Moukda Khounlaboud, Gilbert Habib, Hélène Bardet, Martin Audonnet, Franck Thuny, François Plurien, Alain Berenfeld, Renaud Gervais, Emmanuel Sorbets, Aude Charbonnier, Fabrice Bauer, C. Menager-Gangloff, M. Gjerakorska-Radovikj, S Jordanova, Evren Caglayan, Rainer Hambrecht, İbrahim Akın, Lars S. Maier, G. Nickenig, Werner Scholtz, P. Christian Schulze, Matthias Heintzen, Fikret Er, Holger H. Sigusch, Konstantinos Spargias, Vasileios Kamperidis, Vasileios Sachpekidis, Vasileios Bellos, Ioannis Kanakakis, Michail I. Papafaklis, Angela Makris, Leonidas Poulimenos, Andreas Katsaros, Κωνσταντίνος Λαμπρόπουλος, Elektra Bartha, András Zsáry, Éva Jebelovszki, Attila Cziráki, Tünde Borsányi, Géza Lupkovics, Zoltan Jarai, Pranvera Ibrahimi, Rano Arapova, Elmira Laahunova, Andrejs Ērglis, Iveta Sime, Gita Rancane, V Mizariene, Greta Radauskaitė, Rasa Raugalienė, Robert G. Xuereb, Roxana Djaberi, Monika Komar, Lidia Tomkiewicz‐Pająk, Piotr Szymański, Beata Zaborska, Katarzyna Mizia­‐Stec, M Regulski, Piotr Bogacki, Ewa Sędziwy, K Komor, Jarosław Myszor, I Joao, Rui Martins, Sofia Cabral, Pilar Gago Montaña, Gonçalo Cardoso, Inês Almeida, Nuno Antunes, S Carvalho, A. Galrinho, A. Freitas, Lucica Grigorică, Bogdan A. Popescu, Adriana Mitre, Adina Ionac, Diana Țînț, Andreea C. Popescu, Antoniu Octavian Petriș, Roxana Onuţ, Călin Pop, Cătălin Uşurelu, Ruxandra Beyer, Constantin Militaru, Gabriela Eminovici, Cătălina Arsenescu Georgescu, O. B. Irtyuga, Елена Ивановна Семенова, S. Y. Boldyrev, D. Yu. Kozmin, Y. Gross, Aleksandr Zotov, Denis Kuznetsov, Eugene V Nemchenko, O. I. Kulumbegov, Ramis Jakubov, S B Stefanov, Yu. A. Schneider, Valeriy Tsechanovich, А.Б. Гамзаев, М. С. Фоменко, Olga Mayorova, Elena Skripkina, Vasilya Safina, Yaroslav S. Slastin, Koroleva Tv, Larisa Polyaeva, Igor Tarasenko, Sardana Alekseeva, Victoriya Magamet, И. Н. Медведев, Liliya Khilova, A. Verevetinov, Anastazija Stojšić‐Milosavljević, Nataša Marković, D. Kalimanovska Ostric, Dušan Ružičić, Sonja Pavlović,

Cardiac Structural Anomalies and Repair

Background: Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology to analyze actual management of VHD and to compare practice with guidelines. Methods: Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 European Society of Cardiology and in the 2014 American Heart Association/American College of Cardiology VHD guidelines. Results: A total of 7247 patients (4483 hospitalized, 2764 outpatients) were included in 222 centers. Median age was 71 years (interquartile range, 62–80 years); 1917 patients (26.5%) were ≥80 years; and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis in 2152 (41.2% of native VHD), aortic regurgitation in 279 (5.3%), mitral stenosis in 234 (4.5%), mitral regurgitation in 1114 (21.3%; primary in 746 and secondary in 368), multiple left-sided VHD in 1297 (24.9%), and right-sided VHD in 143 (2.7%). Two thousand twenty-eight patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% CI, 77.1–81.6) for aortic stenosis, 77.6% (95% CI, 69.9–84.0) for aortic regurgitation, 68.5% (95% CI, 60.8–75.4) for mitral stenosis, and 71.0% (95% CI, 66.4–75.3) for primary mitral regurgitation. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with aortic stenosis and 16.7% of those with mitral regurgitation. Conclusions: Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal number in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.