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Indications for echocardiography of replacement heart valves: a joint statement from the British Heart Valve Society and British Society of Echocardiography

Abstract

Echocardiography plays a vital role in the follow-up of patients with replacement heart valves. However, there is considerable variation in international guidelines regarding the recommended time points after implantation at which routine echocardiography should be performed. The purpose of routine echocardiography is to detect early structural valve deterioration in biological valves to improve the timing of redo interventions. However, the risk of valve deterioration depends on many valve-related factors (valve design and patient prosthesis mismatch) and patient-related factors (age, diabetes, systemic hypertension, renal dysfunction and smoking). In this statement, the British Heart Valve Society and the British Society of Echocardiography suggest practical guidance. A plan should be made soon after implantation, but this may need to be modified for individual patients and as circumstances change. It is important that patients are managed in a multidisciplinary valve clinic.

References

  1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2017 38 2739–2791. (https://doi.org/10.1093/eurheartj/ehx391)

    Article  Google Scholar 

  2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajje P, et al. 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. Journal of the American College of Cardiology 2014 63 e57–e185. (https://doi.org/10.1016/j.jacc.2014.02.536)

    Article  Google Scholar 

  3. Chambers JB, Garbi M, Nieman K, Myerson S, Pierard LA, Habib G, Zamorano JL, Edvardsen T, Lancellotti P, et. al. Appropriateness criteria for the use of cardiovascular imaging in heart valve disease in adults: a European Association of Cardiovascular Imaging report of literature review and current practice. European Heart Journal Cardiovascular Imaging 2017 18 489–498. (https://doi.org/10.1093/ehjci/jew309)

    Article  Google Scholar 

  4. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, et al. Guidelines on the management of valvular heart disease (version 2012). European Heart Journal 2012 33 2451–2496. (https://doi.org/10.1093/eurheartj/ehs109)

    Article  Google Scholar 

  5. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. Journal of the American Society of Echocardiography 2009 22 975–1014; quiz 1082. (https://doi.org/10.1016/j.echo.2009.07.013)

    Article  Google Scholar 

  6. Alaour B, Menexi C, Shah BN. Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: a tertiary centre experience. Echo Research and Practice 2018 5 113–119. (https://doi.org/10.1530/ERP-18-0035)

    Article  Google Scholar 

  7. Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, Mirza A, Loardi C, May MA, El-Khoury R, Marchand M, Aupart M. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Annals of Thoracic Surgery 2015 99 831–837. (https://doi.org/10.1016/j.athoracsur.2014.09.030)

    Article  Google Scholar 

  8. Côté N, Pibarot P, Clavel MA. Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration. Current Opinion in Cardiology 2017 32 123–129. (https://doi.org/10.1097/HCO.0000000000000372)

    Article  Google Scholar 

  9. Puri R, Auffret V, Rodés-Cabau J. Bioprosthetic valve thrombosis. Journal of the American College of Cardiology 2017 69 2193–2211. (https://doi.org/10.1016/j.jacc.2017.02.051)

    Article  Google Scholar 

  10. Salaum E, Mahjoub H, Girerd N, Dagenais F, Voisine P, Mohammadi S, Yanagawa B, Kalavrouziotis D, Juni P, Verma S, et al. Rate, timing, correlates, and outcome of hemodynamic valve deterioration after bioprosthetic surgical aortic valve replacement. Circulation 2018 138 971–985. (https://doi.org/10.1161/CIRCULATIONAHA.118.035150)

    Article  Google Scholar 

  11. Lancellotti P, Rosenhek R, Pibarot P, Iung B, Otto CM, Tornos P, Donal E, Prendergast B, Magne J, La Canna G, et al. Heart valve clinics: organisation, structure and experiences. European Heart Journal 2013 34 1597–1606. (https://doi.org/10.1093/eurheartj/ehs443)

    Article  Google Scholar 

  12. Chambers JB, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, Arden C, Wilson J, Campbell B, Sandoe J, et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart 2013 99 1714–1716. (https://doi.org/10.1136/heartjnl-2013-303754)

    Article  Google Scholar 

  13. Parkin D, Chambers J. Routine follow-up for patients with prosthetic valves: the value of a nurse-led valve clinic. British Journal of Cardiology 2012 19 204–206. (https://doi.org/10.5837/bjc.2012.015)

    Article  Google Scholar 

  14. Grunkemeier GL, Li HH, Naftel DC, Starr A, Rahimtoola SH. Long-term performance of heart valve prostheses. Current Problems in Cardiology 2000 25 73–154. (https://doi.org/10.1053/cd.2000.v25.a103682)

    CAS  Article  Google Scholar 

  15. Kunadian B, Vijayalakshmi K, Balasubramanian S, Dunning J. Should the tricuspid valve be replaced with a mechanical or biological valve? Interactive Cardiovascular and Thoracic Surgery 2007 7 551–557. (https://doi.org/10.1510/icvts.2007.159277)

    Article  Google Scholar 

  16. Webb J, Parkin D, Tǿndel K, Simitsis P, Roxburgh J, Chambers JB. A comparison of early redo surgery rates in Mosaic porcine and Perimount bovine pericardial valves. European Journal of Cardio-Thoracic Surgery 2018 54 724–728. (https://doi.org/10.1093/ejcts/ezy113)

    Article  Google Scholar 

  17. Chan V, Kulik A, Tran A, Hendry P, Masters R, Mesana TG, Ruel M. Long-term clinical and hemodynamic performance of the Hancock II versus the Perimount aortic bioprosthesis. Circulation 2010 122 S10–S16. (https://doi.org/10.1161/CIRCULATIONAHA.109.928085)

    Article  Google Scholar 

  18. Flameng W, Herregods MC, Vercalsteren M, Herijgers P, Bogaerts K, Meuris B. Prosthesis-patient mismatch predicts structural valve degeneration in bioprosthetic heart valves. Circulation 2010 121 2123–2129. (https://doi.org/10.1161/CIRCULATIONAHA.109.901272)

    Article  Google Scholar 

  19. Rahimtoola SH. Choice of prosthetic heart valve in adults: an update. Journal of the American College of Cardiology 2010 55 2413–2426. (https://doi.org/10.1016/j.jacc.2009.10.085)

    Article  Google Scholar 

  20. Forcillo J, Pellerin M, Perrault LP, Cartier R, Bouchard D, Demers P, Carrier M. Carpentier-Edwards pericardial valve in the aortic position: 25-years experience. Annals of Thoracic Surgery 2013 96 486–493. (https://doi.org/10.1016/j.athoracsur.2013.03.032)

    Article  Google Scholar 

  21. Banbury MK, Cosgrove DM, White JA, Blackstone EH, Frater RWM, Okies JE. Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Annals of Thoracic Surgery 2001 72 753–757. (https://doi.org/10.1016/S0003-4975(01)02992-7)

    CAS  Article  Google Scholar 

  22. Rodriguez-Gabella T, Voisine P, Puri R, Pibarot P, Rodés-Cabau J. Aortic bioprosthetic valve durability: incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. Journal of the American College of Cardiology 2017 70 1013–1028. (https://doi.org/10.1016/j.jacc.2017.07.715)

    Article  Google Scholar 

  23. Bridgewater B, Keogh B, Kinsman R, Walton P. Demonstrating Quality: the Sixth National Adult Cardiac Surgery Database Report 2008. Henley-on-Thames, UK: Dendrite Clinical Systems Ltd, 2009. (available at: https://scts.org/_userfiles/resources/SixthNACSDreport2008withcovers.pdf)

    Google Scholar 

  24. Briand M, Pibarot P, Despres JP, Voisine P, Dumesnil JG, Dagenais F, Mathieu P. Metabolic syndrome is associated with faster degeneration of bioprosthetic valves. Circulation 2006 114 I512–I517. (https://doi.org/10.1161/CIRCULATIONAHA.105.000422)

    Article  Google Scholar 

  25. Lorusso R, Gelsomino S, Luca F, De Cicco G, Bille G, Carella R, Villa E, Troise G, Vigano M, Banfi C, et al. Type 2 diabetes mellitus is associated with faster degeneration of bioprosthetic valve: results from a propensity score-matched Italian multicenter study. Circulation 2012 125 604–614. (https://doi.org/10.1161/CIRCULATIONAHA.111.025064)

    Article  Google Scholar 

  26. Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical bioprosthetic valves. European Heart Journal 2017 38 3382–3390. (https://doi.org/10.1093/eurheartj/ehx303)

    Article  Google Scholar 

  27. Dvir D, Bourgignon T, Otto CM, Hahn RT, Rosenhek R, Webb JG, Treede H, Sarano ME, Feldman T, Wijeysundera HC, et al. Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation 2018 137 388–399. (https://doi.org/10.1161/CIRCULATIONAHA.117.030729)

    Article  Google Scholar 

  28. Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, Sicari R, Nihopyannopouls P, Zamorano J, European Association of Echocardiography, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. European Journal of Echocardiography 2010 11 645–658. (https://doi.org/10.1093/ejechocard/jeq056)

    Article  Google Scholar 

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Correspondence to John B. Chambers MD FACC FESC.

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J Chambers, V Sharma and R Steeds are members of the editorial board of Echo Research and Practice. They were not involved in the review or editorial process for this paper, on which they are listed as authors

(V Sharma is the Guidelines Chair)

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Chambers, J.B., Garbi, M., Briffa, N. et al. Indications for echocardiography of replacement heart valves: a joint statement from the British Heart Valve Society and British Society of Echocardiography. Echo Res Pract 6, G10–G16 (2019). https://doi.org/10.1530/ERP-18-0079

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Key Words

  • valve replacement
  • echocardiography
  • valve clinic
  • structural valve deterioration