Management of aortic stenosis : A systematic review of clinical practice guidelines and recommendations
(2021) In European Heart Journal - Quality of Care and Clinical Outcomes 7(4). p.340-353- Abstract
Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations.... (More)
Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.
(Less)
- author
- Khanji, Mohammed Y. ; Ricci, Fabrizio LU ; Galusko, Victor ; Sekar, Baskar ; Chahal, C. Anwar A. ; Ceriello, Laura ; Gallina, Sabina ; Kennon, Simon ; Awad, Wael I. and Ionescu, Adrian
- organization
- publishing date
- 2021-10-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aortic stenosis, Aortic valve replacement, Guidelines recommendations, TAVI, Transcatheter aortic valve implantation
- in
- European Heart Journal - Quality of Care and Clinical Outcomes
- volume
- 7
- issue
- 4
- pages
- 14 pages
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85112224509
- pmid:33751049
- ISSN
- 2058-5225
- DOI
- 10.1093/ehjqcco/qcab016
- language
- English
- LU publication?
- yes
- id
- e5cfd932-9be4-43c4-9dea-d62f6ba41593
- date added to LUP
- 2021-09-08 13:38:07
- date last changed
- 2024-06-16 18:34:08
@article{e5cfd932-9be4-43c4-9dea-d62f6ba41593,
abstract = {{<p>Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients. </p>}},
author = {{Khanji, Mohammed Y. and Ricci, Fabrizio and Galusko, Victor and Sekar, Baskar and Chahal, C. Anwar A. and Ceriello, Laura and Gallina, Sabina and Kennon, Simon and Awad, Wael I. and Ionescu, Adrian}},
issn = {{2058-5225}},
keywords = {{Aortic stenosis; Aortic valve replacement; Guidelines recommendations; TAVI; Transcatheter aortic valve implantation}},
language = {{eng}},
month = {{10}},
number = {{4}},
pages = {{340--353}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal - Quality of Care and Clinical Outcomes}},
title = {{Management of aortic stenosis : A systematic review of clinical practice guidelines and recommendations}},
url = {{http://dx.doi.org/10.1093/ehjqcco/qcab016}},
doi = {{10.1093/ehjqcco/qcab016}},
volume = {{7}},
year = {{2021}},
}