Abstract
The management of valvular heart disease has changed dramatically over the past decade
with advances in cardiac imaging, the use of novel biomarkers, and the development
of transcatheter valve repair and replacement technology. International society guidelines
have kept pace to provide recommendations for diagnosis, follow-up, and timing of
intervention. The most challenging patient cohort for clinicians are patients with
asymptomatic severe disease in whom the optimal timing of intervention can be ill-defined.
It is a fine balance between the risks of early intervention on asymptomatic patients
and improving patient outcomes by preventing long-term cardiac complications. The
key in optimal patient management is gathering the necessary information on patient
risk and combining that with the risk, efficacy, and durability of valve interventions
to arrive at the appropriate timing for intervention. This group of patients will
be the focus of this review as we delve into the natural history, recommended follow-up,
and indications for intervention in patients with degenerative aortic and mitral valve
disease.
Résumé
La prise en charge de la cardiopathie valvulaire a considérablement évolué au cours
de la dernière décennie grâce aux progrès de l'imagerie cardiaque, à l'utilisation
de nouveaux biomarqueurs et au développement de la technologie de réparation et de
remplacement de valve par cathéter. Les lignes directrices de la société internationale
ont évolué au même rythme pour fournir des recommandations sur le diagnostic, le suivi
et le moment de l'intervention. La cohorte de patients la plus difficile à appréhender
pour les cliniciens est celle des patients atteints d'une maladie grave asymptomatique
chez lesquels le moment optimal de l'intervention peut être difficile à définir. Il
s'agit d'un équilibre délicat entre les risques d'une intervention précoce chez les
patients asymptomatiques et l'amélioration du pronostic des patients en prévenant
les complications cardiaques à long terme. L’élément clé de la prise en charge optimale
des patients consiste en un regroupement des informations nécessaires concernant le
risque du patient et de les combiner avec le risque, l'efficacité et la durabilité
des interventions valvulaires pour déterminer un moment approprié pour l'intervention.
Ce groupe de patients sera au centre de cette revue de littérature, et nous explorerons
les antécédents, le suivi recommandé et les indications d'intervention chez les patients
atteints de valvulopathie aortique et mitrale dégénérative.
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Article info
Publication history
Published online: May 11, 2021
Accepted:
May 3,
2021
Received:
March 24,
2021
Footnotes
See page 1051 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
