Cardiovascular Critical Care I
Valvular
Disease Type
Management Considerations
Tricuspid
regurgitation
(TR)
| • | Likely to influence pulmonary artery catheter assessments of cardiac output by way of |
|---|
thermodilution technique
| • | Can be influenced by infectious causes and presence of indwelling transvenous catheters |
|---|
or leads; but moderate or severe TR is more commonly a marker of RV overload and
dysfunction
aInfective endocarditis can cause progressive valve disease, leading to regurgitant flow and impaired valve leaflet coaptation; however, it can also lead to near obstruction
in some cases.
bDegree of valvular disease is graded as mild, moderate, or severe, as defined by objective ECHO or catheter-based assessments.
early/2017/03/14/CIR.0000000000000503)
Balloon
valvuloplasty
| • | Performed by percutaneous intervention as a temporizing intervention |
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Valve repair
| • | May entail direct surgical repair of a damaged valve leaflet or implantation of a ring at the |
|---|
valve annulus to facilitate improved coaptation of a regurgitant valve
Tissue
(bioprosthetic)
valve
| • | Made of animal or human tissue |
|---|---|
| • | Usually does not require long-term anticoagulation (see Table 15) |
| • | Does not last as long as a mechanical valve (may last 10–15 yr) |
Mechanical valve
| • | Made of synthetic materials (newer valves use ceramic or carbon) |
|---|---|
| • | They are durable and generally unlikely to need replacement |
| • | Require lifelong anticoagulation |
| • | Warfarin is currently the only anticoagulant approved for use by the FDA in patients with |
mechanical heart valves (see Table 15)
Transcatheter
aortic valve
replacement
(TAVR)
| • | Made of animal tissue (bioprosthetic) and attached to a wire frame stent and placed using |
|---|
catheter inside the old aortic valve
| • | This may be considered in patients who are at higher perioperative risk for surgical aortic |
|---|
valve replacement or when surgery is not an option
| • | Anticoagulation and/or antiplatelet agents are required for at least a short time after TAVR |
|---|
Transcatheter
edge-to-edge
repair (TEER)
| • | Minimally invasive technique for treatment of symptomatic chronic moderate-severe or |
|---|
severe primary (degenerative) mitral regurgitation in patients at prohibitive surgical risk
| • | A leaflet repair device (MitraClip) is currently the only FDA approved device for this |
|---|
indication
| • | This device uses a cobalt chromium clip to suture the regurgitant orifices of the mitral |
|---|
valve leaflets together, thereby increasing coaptation
| • | Anticoagulation and/or antiplatelet agents are required for at least a short time after TEER |
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(continued)