ACC/AHA Versus ESC Guidelines on Prosthetic Heart Valve Management: JACC Guideline Comparison

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Prosthetic heart valve interventions are advancing with new surgical and transcatheter techniques.
• Established guidelines exist for managing patients with these devices.

Purpose of the Study:

• To compare the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines with the 2017 European Society of Cardiology (ESC) guidelines for prosthetic heart valve management.
• To identify and analyze discrepancies between the two major guideline documents.

Main Methods:

• Comparative analysis of the 2017 ACC/AHA and ESC guidelines.
• Review of current evidence related to areas of guideline divergence.

Main Results:

• Significant differences were noted in recommendations for follow-up imaging frequency and modality.
• Discrepancies exist regarding the preferred type of prosthesis (biological vs. mechanical) and the use of bridging anticoagulation.
• Variations in recommendations were found for aspirin use, fibrinolytic therapy for prosthetic valve thrombosis, and management of paravalvular regurgitation.

Conclusions:

• The review highlights critical areas where ACC/AHA and ESC guidelines diverge on prosthetic heart valve management.
• Understanding these differences is crucial for clinicians to provide optimal, evidence-based care.
• Recommendations are offered to address these controversial areas and guide clinical practice.