Science News: 2014 Heart Valve Disease Management Guidelines Announced by the AHA / ACC

By Adam Pick on March 5, 2014

If you didn’t know, there are physician guidelines for the management and treatment of heart valve disease. These guidelines, which were created by the American Heart Association and the American College of Cardiology, are used by your cardiologist and heart surgeon to determine the best approach for the treatment of valvular disorders including aortic stenosis and mitral regurgitation.

The big news of the week is that the 2014 guidelines have just been released. To help you learn why these guidelines are so important, here is a video with Dr. Robert Bonow, a leading cardiologist at Northwestern Medicine, who has been working on these guidelines for many years.



Video Transcript About The 2014 Guidelines For Heart Valve Disease

For the hearing impaired members of our community, I created a a written transcript of Dr. Bonow’s video to help you learn more about the management of heart valve disease guidelines in 2014.

Dr. Robert Bonow says: I’m Robert Bonow at Northwestern University and Northwestern Memorial Hospital in Chicago, and I’m delighted that the American College of Cardiology and American Heart Association Guidelines on Management of Valvular Heart Disease are being released now, in 2014, after several years of deliberation and revision from the previous guidelines. The last guidelines were actually written in 2006, so it’s been eight years. Even though there was an update in 2008, very little happened between 2006 and 2008 in those guidelines, but a lot has happened in valvular heart disease over the last six to eight years. It’s good that we’re now getting this revision out to the practicing community to help us manage all of our patients with valve disease. A couple of really important updates here.  First of all, these guidelines were chaired by Rick Nishimura at the Mayo Clinic and Catherine Otto at the University of Washington, and Doctors Nishimura and Otto did a great job of rounding up those of us on the committee and getting our thoughts together.


AHA & ACC Logo


One thing, which is brand new, is to look at valve disease the way we look at heart failure at various stages of progression of disease and severity of disease. So, we have Stage A, which is when people are at risk of developing valve disease; for example, someone with a bicuspid aortic valve that is not yet stenotic or mitral valve prolapse without regurgitation. Stage B is when patients already have disease, but they’re asymptomatic and it’s mild. C is when patients have severe disease but are asymptomatic, and D is when patients have symptomatic severe disease. This is very much the way we look at heart failure. Once we categorize patients that way, then it’s much easier to discuss management strategies at each stage of the disease and how we treat these patients differently according to the guidelines-based approach. That’s one way which we’re now beginning to look at things, which is really brand new and probably quite important as we go forward.

The other thing we’re bringing into the guidelines now are the transcatheter valve procedures for treating patients with aortic stenosis or mitral regurgitation. In fact, that’s why the timing is what it is, because we couldn’t write those guidelines until we had approved devices in the United States. That’s why the European guidelines came out two years ahead of ours, because they already had those devices approved. With these devices now approved, we have recommendations for the use of transcatheter aortic valve replacement and also for the use of the mitral clip for treating patients with very symptomatic but high-risk mitral valve regurgitation. That’s also now embedded in our guidelines for the first time. We’ve streamlined some of the recommendations for how to treat patients and when to treat patients with aortic stenosis with particular emphasis now on looking at patient’s who may be asymptomatic with severe aortic stenosis and moving more towards surgery and not waiting for symptoms when the aortic valve is severely stenotic, as well as patients with mitral regurgitation.  When there is severe regurgitation, we have a IIa indication for considering surgery in patients who have repairable mitral valves, if we can send them to a surgical center where there’s great experience. But now instead of saying this should be a 90% or greater likelihood the valve will get repaired instead of replaced, we’re saying it should be 95%.  We really want to make sure patients are going to an experienced center.

That’s the other part of the guidelines, which I think are worth emphasizing.  We and others are really emphasizing the heart team approach. The patient should be referred to centers where there is expertise in diagnosis and treatment. That means a center where there are cardiologists, cardiac surgeons, and nurses and many other times, anesthesiologists, who are developing a heart care center of excellence to really manage our patients in the most expeditious and optimal way. That’s something I think we ahve built into the guidelines from stem to stern. We’re looking forward to seeing how these guidelines play out in the community. I think that the practicing physicians and nurses will see that there’s much more substance here than previously, and let’s hope that this also leads to improved patient care.

Many thanks to Dr. Robert Bonow and Dr. Patrick McCarthy for sharing this exciting news with me!

Keep on tickin!

Written by Adam Pick
- Patient & Website Founder

Adam Pick, Heart Valve Patient Advocate

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Nan says on March 5th, 2014 at 8:05 pm

When do you do surgery if you have severe aortic regurgitation and moderate-severe stenosis and don’t have the usual symptoms of ankle swelling? No one can agree here (St. Paul, MN) when to do the surgery. I have been to the Mayo and Abbott Northwestern, neither facility could agree between the surgeon and cardiologist, most wanted me to wait until I had symptoms they thought was heart related. What are the symptoms?

Is it possible to read these guidelines as a patient?

Adam Pick says on March 5th, 2014 at 8:18 pm

Hi Nan,

You can get a copy of the 235-page guidelines by clicking the PDF link at:

Keep on tickin!

belle says on March 6th, 2014 at 2:34 am

is it safe and okay for me to get pregnant if i have a mechanical valve? cause i need to have an operation,i have a mitral valve stenosis with moderate pulmonary hypertension.

Mark RIdder says on March 6th, 2014 at 9:11 am

As a heart valve patient myself, I am always very interested in the latest research and information on the treatment of this disease. The release of the new guidelines for diagnosis and treatment of valvular disease should hopefully bring improved clarity to the tracking of disease progression in patients and the timing of any intervention. My own situation with a bicuspid aortic valve would have been managed more effectively I believe if these new guidelines had been in place earlier in my life (I’m now 61 years old). The release of these guidelines a full two years after the European model should remind us all again that we have a more cumbersome and delayed approval process here in the U.S.. I believe this puts U.S. patients at a disadvantage when it comes to new and innovative treatments for many disease states including valvular disease.

Lloyd Eisen says on March 6th, 2014 at 10:10 am

i am 63 and had bicuspid aortic valve replacment last year with st judes bovine tissue valve at U of P after repair of my bicuspid aortic valve in 1999 at Cleveland Clinic which had been done minimally invasively. so question is, if as and when this tissue valve needs replacement again say hopefully in not less than 15 years, will Tavi valves be the thing or third open heart surgeries ? Are third surgeries possible and reasonably successfull……..? thanks LLoyd

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