Surgical Valve Procedures Risk Assessment
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Questions and Answers

What is the purpose of performing a dental examination before valve intervention?

  • To rule out potential infection sources (correct)
  • To determine cardiac function
  • To assess coronary anatomy
  • To evaluate recovery chances

    • Which test provides prognostic markers for further risk stratification in patients with known or suspected VHD?

  • CMR imaging
  • Frality score assessment
  • Stress testing (correct)
  • Dental examination

    • What does the frailty score assess in patients undergoing valve procedures?

  • Quality of life pre-procedure
  • Future risk of valve disease
  • Procedure recovery chances and risks (correct)
  • Coronary anatomy assessment

    • Which imaging technique is used to assess suitability for TAVI?

    <p>Computed tomography of the cardiac region</p> Signup and view all the answers

    What is the role of the STS score in evaluating patients with VHD?

    <p>Quantifies procedural risk and predicted mortality</p> Signup and view all the answers

    What does the CT: peripheral test specifically assess in the context of transcatheter procedures?

    <p>Femoral access suitability</p> Signup and view all the answers

    Why might a CMR indicate cardiac magnetic resonance imaging be ordered for a patient with suspected VHD?

    <p>To evaluate cardiac structure and function</p> Signup and view all the answers

    Which test is essential for providing an assessment of coronary anatomy before valve intervention?

    <p>Invasive coronary angiogram</p> Signup and view all the answers

    What defines a Low-Risk Surgical Aortic Valve Replacement (SAVR)?

    <p>Patient has no major organ system compromise.</p> Signup and view all the answers

    Which criterion indicates a High Surgical Risk for surgical valve procedures?

    <p>≥3 organ systems impacted.</p> Signup and view all the answers

    What is a requirement for Low-Risk Surgical Mitral Valve Repair for Primary MR?

    <p>No major organ system compromise.</p> Signup and view all the answers

    What characterizes the Prohibitive Surgical Risk category?

    <p>Severe procedure-specific impediment expected.</p> Signup and view all the answers

    Which statement about the STS-predicted risk of mortality is TRUE for low-risk assessments?

    <p>It should be within 1 standard deviation of STS averages.</p> Signup and view all the answers

    What is a necessary consideration if using the EUROSCORE II risk calculator?

    <p>It should reflect realism based on local patient outcomes.</p> Signup and view all the answers

    In which scenario would a patient be classified as Low-Risk?

    <p>No cardiac complications are found.</p> Signup and view all the answers

    What is an example of a criterion for High Surgical Risk?

    <p>Presence of severe procedure-specific impediment.</p> Signup and view all the answers

    What characterizes Stage A of valve heart disease (VHD)?

    <p>Patients with risk factors for development of VHD</p> Signup and view all the answers

    In which stage do patients exhibit symptoms due to severe valve heart disease?

    <p>Stage D</p> Signup and view all the answers

    How often should an asymptomatic patient with mild aortic stenosis be followed up with an echocardiogram?

    <p>Every 3–5 years</p> Signup and view all the answers

    What does Stage C1 indicate in patients with valve heart disease?

    <p>Asymptomatic patients with compensated severe VHD</p> Signup and view all the answers

    For patients with moderate mitral regurgitation, how frequent should echocardiographic evaluations be conducted?

    <p>Every 1–2 years</p> Signup and view all the answers

    What condition falls under the description of Stage B in valve heart disease?

    <p>Patients with mild to moderate asymptomatic VHD</p> Signup and view all the answers

    Which of these statements about mixed valve disease is true?

    <p>They may necessitate earlier serial evaluations than recommended for single-valve lesions.</p> Signup and view all the answers

    What defines Stage C2 in the classification of valve heart disease?

    <p>Asymptomatic patients with decompensated LV or RV</p> Signup and view all the answers

    What is a key consideration when choosing an intervention for a patient with severe aortic stenosis?

    <p>Shared decision-making process involving valve types and approaches</p> Signup and view all the answers

    What is the primary indication for intervention in cases of valvular regurgitation?

    <p>Relief of symptoms and prevention of irreversible left ventricular volume overload</p> Signup and view all the answers

    Who benefits most from a percutaneous edge-to-edge mitral repair?

    <p>Patients with severely symptomatic primary or secondary mitral regurgitation at high risk for surgery</p> Signup and view all the answers

    What is an important factor to consider for patients with severe symptomatic isolated tricuspid regurgitation?

    <p>Early intervention can prevent severe right ventricular dysfunction and end-organ damage</p> Signup and view all the answers

    What causes bioprosthetic valve dysfunction?

    <p>Degeneration of valve leaflets or valve thrombosis</p> Signup and view all the answers

    Which of the following statements is true about catheter-based treatment for prosthetic valve dysfunction?

    <p>It can be reasonable for selected cases of bioprosthetic leaflet degeneration or paravalvular leak</p> Signup and view all the answers

    Why have the thresholds for intervention in valvular regurgitation lowered?

    <p>More durable treatment options and reduced procedural risks</p> Signup and view all the answers

    What risk factors are commonly associated with severe symptomatic isolated tricuspid regurgitation?

    <p>Presence of device leads and atrial fibrillation</p> Signup and view all the answers

    What factors are used to classify disease stages in patients with valvular heart disease?

    <p>Symptoms, valve anatomy, severity of valve dysfunction, and response of the ventricle</p> Signup and view all the answers

    When should further noninvasive or invasive testing be considered for valvular heart disease patients?

    <p>When there is discordance between the physical examination and noninvasive testing</p> Signup and view all the answers

    Which patients with atrial fibrillation and valvular heart disease should receive a vitamin K antagonist for anticoagulation?

    <p>Patients with rheumatic mitral stenosis or mechanical prosthesis</p> Signup and view all the answers

    What is the recommended approach for patients with severe valvular heart disease regarding valve intervention?

    <p>Evaluation by a multidisciplinary team</p> Signup and view all the answers

    What should primarily guide the treatment of severe aortic stenosis?

    <p>Symptom severity or reduced ventricular systolic function</p> Signup and view all the answers

    Which approach is suggested for the decision-making process regarding anticoagulation in patients with atrial fibrillation?

    <p>Shared decision-making based on the CHA2DS2-VASc score</p> Signup and view all the answers

    In light of recent trials, what is true about transcatheter aortic valve implantation?

    <p>Its indications are expanding</p> Signup and view all the answers

    Which of the following is NOT a recommended evaluation for patients with valvular heart disease?

    <p>Physical examination alone</p> Signup and view all the answers

    Study Notes

    Surgical Valve Procedures Risk Assessment

    • Low-Risk SAVR (Surgical Aortic Valve Replacement): Must meet all criteria in this column.
      • STS (Society of Thoracic Surgeons)-predicted risk of mortality: 50% at 1 year.
      • Frailty: None
      • Cardiac or other major organ system compromise: None.
    • Low-Risk Surgical Mitral Valve Repair for Primary MR: Must meet all criteria in this column.
      • STS-predicted risk of mortality: 50% at 1 year.
      • Frailty: None
      • Cardiac or other major organ system compromise: None.
    • High Surgical Risk: Any one criterion in this column.
      • STS-predicted risk of mortality: 50% at 1 year.
      • Frailty: ≥ 2 Indices (moderate to severe)
      • Cardiac or other major organ system compromise: 1 to 2 organ systems
      • Procedure-specific impediment: Possible procedure-specific impediment.
    • Prohibitive Surgical Risk: Any one criterion in this column.
      • Frailty: ≥ 2 Indices (moderate to severe)
      • Cardiac or other major organ system compromise: ≥ 3 organ systems.
      • Procedure-specific impediment: Severe procedure-specific impediment.

    Evaluation of Patients with Known or Suspected VHD

    • Further risk stratification:
      • Stress testing: Provides prognostic markers, information on future risk of valve disease, and important for determining timing of intervention.
      • Procedural risk: Quantified by STS (Predicted Risk of Mortality) and TAVI scores.
      • Frailty score: Provides assessment of risk of procedure and chance of recovering quality of life.
    • Preprocedural Testing:
      • Dental examination: Rules out potential infection sources.
      • CT coronary angiogram or invasive coronary angiogram: Provides an assessment of coronary anatomy.
      • CT (Computed Tomography): Peripheral - Assess femoral access for TAVI (Transcatheter Aortic Valve Implantation) and other transcatheter procedures.
      • CT (Computed Tomography): Cardiac - Assesses suitability for TAVI and other transcatheter procedures.

    Stages of VHD (Valvular Heart Disease)

    • Stage A: At risk: Patients with risk factors for developing VHD.
    • Stage B: Progressive: Patients with progressive VHD, mild to moderate severity, and asymptomatic.
    • Stage C: Asymptomatic severe: Asymptomatic patients who have severe VHD.
      • C1: Asymptomatic patients with severe VHD where the LV (Left Ventricular) or RV (Right Ventricular) remains compensated.
      • C2: Asymptomatic patients with severe VHD with decompensation of LV or RV.
    • Stage D: Symptomatic severe: Patients who have developed symptoms as a result of VHD.

    Diagnostic Testing and Follow-Up:

    • Frequency of Echocardiograms in Asymptomatic Patients with VHD and Normal LV Function:
      • Aortic Stenosis:
        • Every 3–5 years for mild severity (Vmax 2.0–2.9 m/s)
        • Every 1–2 years for moderate severity (Vmax 3.0–3.9 m/s)
      • Aortic Regurgitation:
        • Every 3–5 years for mild severity
        • Every 1–2 years for moderate severity.
      • Mitral Stenosis:
        • Every 3–5 years (MV area >1.5 cm2)
      • Mitral Regurgitation:
        • Every 3–5 years for mild severity
        • Every 1–2 years for moderate severity.

    Top 10 Take Home Messages:

    • Evaluating a patient with valvular heart disease should involve a correlation of history and physical examination with results of noninvasive testing. If findings are discordant, consider additional noninvasive or invasive testing to determine the optimal treatment strategy.
    • For patients with valvular heart disease and atrial fibrillation (except for patients with rheumatic mitral stenosis or a mechanical prosthesis), the decision to use oral anticoagulation to prevent thromboembolic events should be made with a shared decision-making process based on the CHA2DS2-VASc score.
    • All patients with severe valvular heart disease considering valve intervention should be evaluated by a multidisciplinary team.
    • Treatment of severe aortic stenosis should be based primarily on symptoms or reduced ventricular systolic function.
    • Indications for transcatheter aortic valve implantation are expanding, and the choice of intervention should be a shared decision-making process considering the benefits and risks.
    • Indications for intervention for valvular regurgitation are relief of symptoms and prevention of long-term consequences of left ventricular overload.
    • A percutaneous edge-to-edge mitral repair benefits patients with severely symptomatic primary mitral regurgitation who are at high or prohibitive risk for surgery.
    • Patients with severe symptomatic isolated tricuspid regurgitation may benefit from surgical intervention to reduce symptoms and recurrent hospitalizations.
    • Bioprosthetic valve dysfunction may occur due to degeneration of the valve leaflets or valve thrombosis. Catheter-based treatment is reasonable for bioprosthetic leaflet degeneration or paravalvular leak in the absence of active infection.

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    Related Documents

    2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease PDF

    Description

    This quiz evaluates the criteria for low, high, and prohibitive surgical risks in valve procedures, including Surgical Aortic Valve Replacement and Mitral Valve Repair. Assess your understanding of patient frailty and other risk factors that influence surgical outcomes. Test your knowledge on the Society of Thoracic Surgeons' predicted risk assessments.

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