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Canadian Journal of Cardiology

Optimizing Timing of Valve Intervention in Patients With Asymptomatic Severe Valvular Heart Disease

      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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