The Society of Thoracic Surgeons (STS) published an executive summary of clinical practice guidelines on aortic valve and ascending aorta procedures in the April issue of The Annals of Thoracic Surgery. The guidelines focus on adult patients and evolving technologies such as those used in transcatheter aortic valve replacement.
The authors, led by Lars G. Svensson, MD, from the Cleveland Clinic, outlined several reasons to add to previous guidelines by the American College of Cardiology and American Heart Association in 2008 and multiple societies in 2010. Those reasons include an opportunity to elaborate on pros and cons; gaps in evidence that need further research; technical updates; quality measure recommendations; and details on new STS valve data collection variables.
The writing committee noted the “dearth of prospective randomized trials that have shown definitive superiority of one procedure over others.” Consequently, the guidelines draw from other resources such as nonrandomized trials, observational studies, registries and other scientific materials. The authors proposed that the new STS valve data module will help inform future endeavors.
“Clearly, this will raise new questions that will result in the evolution and iteration of newer guidelines based on future studies and the data collected by the STS ACDS [Adult Cardiac Surgery Database],” they wrote.
Topics covered in the executive summary include an update of previous guidelines followed by recommendations on aortic stenosis; aortic regurgitation; aortic valve endocarditis; echocardiography; exercise testing; dobutamine stress echocardiography and cardiac catheterization for low-flow and low-gradient stenosis; cardiac catheterization; cannulation options for aortic valve and root surgery; and mechanical aortic valves.
The complete guidelines and a more detailed discussion of aortic valve replacement, outcomes and trends will be published as a supplement in an upcoming issue of the of The Annals of Thoracic Surgery.