2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

Rick A. NishimuraProfessor of medicine, Mayo Clinic

“Due to more knowledge regarding the natural history of untreated patients with severe VHD and better outcomes from surgery, we've lowered the threshold for operation to include more patients with asymptomatic severe valve disease. Now, select patients with severe asymptomatic aortic stenosis and severe asymptomatic mitral regurgitation can be considered for intervention, depending on certain other factors, such as operative mortality and in the case of mitral regurgitation, the ability to achieve a durable valve repair.”

Rick A. NishimuraProfessor of medicine, Mayo Clinic

“We needed to do things differently. These guidelines were created in a different format from prior valvular heart disease guidelines. We wanted these guidelines to promote access to concise, relevant bytes of information at the point of care.”

James D. ThomasCardiologist, Cleveland Clinic

“There has been a slight move toward earlier surgery or earlier intervention since over time our surgical interventions have gotten safer, we have more information on the natural history of these diseases, and we better understand the importance of intervening before there is deterioration in left ventricular function. For instance, in aortic stenosis, there are now more options for intervening in asymptomatic patients if they have really severe aortic stenosis, with valve gradients >100 mm Hg. Those are somewhat more liberal than they have been in the past.”