2020 ACC/AHA Guidelines & 2021 ESC Guidelines for “Valvular Heart Disease”
2020 ACC/AHA Guidelines & 2021 ESC Guidelines for “Valvular Heart Disease”
Ultra-Short Summary:
Management of Severe Mitral Regurgitation (MR)
1. Primary (degenerative) MR is mainly treated by surgical repair; replacement is used if repair is not possible.
2. Transcatheter edge-to-edge repair (TEER) is an option for high-risk surgical patients.
3. Surgery is indicated in symptomatic patients or asymptomatic patients with LV dysfunction, atrial fibrillation, or pulmonary hypertension.
4. In functional (secondary) MR, first-line treatment is guideline-directed medical therapy (GDMT) for heart failure.
5. If symptoms persist despite GDMT, TEER is preferred; surgery is reserved for selected cases.
6. Use of Surgery or TEER in Functional MR:
• Functional (secondary) MR:
• First-line treatment: Guideline-directed medical therapy (GDMT) for heart failure.
• If symptoms persist despite GDMT:
• TEER (e.g., MitraClip) is recommended for selected patients (based on COAPT trial).
• Surgery is considered if the patient undergoes other cardiac surgery (e.g., CABG) or in highly selected cases.
Key Points:
• Primary (degenerative) MR: Surgery is the main treatment.
• Secondary (functional) MR: Focus is on medical therapy first, TEER if needed, surgery in specific cases.
1-2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease:
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2-2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease:
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
