American College of Cardiology Representative.
Society for Cardiovascular Angiography and Interventions Representative.
Eur J Cardiothorac Surg. 2018 Feb 1;53(2):306-308y. doi: 10.1093/ejcts/ezx389.
The American College of Cardiology collaborated with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons to develop and evaluate Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis (AS). This is the first AUC to address the topic of AS and its treatment options, including surgical aortic valve replacement and transcatheter aortic valve replacement. A number of common patient scenarios experienced in daily practice were developed along with assumptions and definitions for those scenarios, which were all created using guidelines, clinical trial data and expert opinion in the field of AS. The '2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines' [1] and its 2017 focused update paper [2] were used as the primary guiding references in developing these indications. The Writing Group identified 95 clinical scenarios based on patient symptoms and clinical presentation, and up to 6 potential treatment options for those patients. A separate, independent Rating Panel was asked to score each indication from 1 to 9, with 1-3 categorized as 'Rarely Appropriate', 4-6 as 'May Be Appropriate' and 7-9 as 'Appropriate'. After considering factors such as symptom status, left ventricular function, surgical risk, and the presence of concomitant coronary or other valve disease, the Rating Panel determined that either surgical aortic valve replacement or transcatheter aortic valve replacement is appropriate in most patients with symptomatic AS at intermediate or high surgical risk; however, situations commonly arise in clinical practice in which the indications for surgical aortic valve replacement or transcatheter aortic valve replacement are less clear, including situations in which one form of valve replacement would appear reasonable when the other is less so, as do other circumstances in which neither intervention is the suitable treatment option. The purpose of this AUC is to provide guidance to clinicians in the care of patients with severe AS by identifying the reasonable treatment and intervention options available based on the myriad clinical scenarios with which patients present. This AUC document also serves as an educational and quality improvement tool to identify patterns of care and reduce the number of rarely appropriate interventions in clinical practice.
美国心脏病学会与美国胸外科学会、美国心脏协会、美国超声心动图学会、欧洲心胸外科学会、心脏瓣膜学会、心血管麻醉学会、心血管血管造影和介入学会、心血管计算机断层扫描学会、心血管磁共振学会和胸外科医师学会合作，制定并评估了严重主动脉瓣狭窄（AS）患者治疗的适用标准（AUC）。这是第一个针对 AS 及其治疗选择的 AUC，包括外科主动脉瓣置换和经导管主动脉瓣置换。根据指南、临床试验数据和 AS 领域的专家意见，制定了一些在日常实践中常见的患者情况假设和定义。“2014 年 AHA/ACC 瓣膜性心脏病患者管理指南：美国心脏病学会/美国心脏协会实践指南工作组的报告”[1]及其 2017 年重点更新文件[2]被用作制定这些适应证的主要指导参考。写作小组根据患者症状和临床表现确定了 95 个临床场景，并为这些患者提供了多达 6 种潜在的治疗选择。一个独立的、独立的评估小组被要求对每个适应证进行 1-9 分的评分，1-3 分归类为“很少适当”，4-6 分归类为“可能适当”，7-9 分归类为“适当”。在考虑症状状态、左心室功能、手术风险以及是否存在合并冠状动脉或其他瓣膜疾病等因素后，评估小组确定在中高危手术风险的有症状 AS 患者中，大多数患者都适合外科主动脉瓣置换或经导管主动脉瓣置换；然而，在临床实践中，经常出现外科主动脉瓣置换或经导管主动脉瓣置换的适应证不太明确的情况，包括一种瓣膜置换形式似乎合理而另一种不太合理的情况，以及其他情况下两种干预都不是合适的治疗选择。本 AUC 的目的是通过确定基于患者就诊的众多临床情况的合理治疗和干预选择，为临床医生治疗严重 AS 患者提供指导。本 AUC 文件也是一种教育和质量改进工具，可识别护理模式并减少临床实践中很少适当干预的数量。
