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Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations

Galusko, V; Thornton, G; Jozsa, C; Sekar, B; Aktuerk, D; Treibel, TA; Petersen, SE; ... Khanji, MY; + view all (2022) Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations. European Heart Journal - Quality of Care and Clinical Outcomes 10.1093/ehjqcco/qcac001. (In press).

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Abstract

Guidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations which do not always match. We systematically reviewed clinical practice guidelines and summarised similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and EMBASE (01/01/2011 - 01/09/2021), Google Scholar, and websites of relevant organisations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3-D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.

Type: Article
Title: Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations
DOI: 10.1093/ehjqcco/qcac001
Publisher version: https://doi.org/10.1093/ehjqcco/qcac001
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: aortic regurgitation, guidelines, systematic review, valvular heart disease, aortic valve
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10142222
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