Rossi A, Dini FL, Faggiano P, et al. Independent prognostic value of func- tional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated car- diomyopathy. Heart. 2011;97:1675 80. 27. Mihaljevic T, Lam B-K, Rajeswaran J, et al. Impact of mitral valve annulo- plasty combined with revascularization in patients with functional isch- emic mitral regurgitation. J Am Coll Cardiol. 2007;49:2191 201. 28. Harris KM, Sundt TM 3rd, Aeppli D, et al. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg. 2002;74:1468 75. 29. Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 pa- tients. J Cardiovasc Med (Hagerstown). 2009;10:109 14. 30. Cohn LH, Rizzo RJ, Adams DH, et al. The effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement. Eur J Cardiothorac Surg. 1995;9:568 74. 31. Chan KMJ, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evalu- ation (RIME) trial. Circulation. 2012;126:2502 10. 32. Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus re- placement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370:23 32. 33. Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume: character- istic differences based on primary cardiac lesion. J Thorac Cardiovasc Surg. 1999;117:463 71. 34. Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation. 2006;114:I582 7. 35. Ling LF, Obuchowski NA, Rodriguez L, et al. Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr. 2012;25:709 13. 36. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685 713. 37. Beygui F, Furber A, Del pine S, et al. Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, repro- ducibility and coherence study. Int J Cardiovasc Imaging. 2004;20:509 16. 38. Caudron J, Fares J, Vivier P-H, et al. Diagnostic accuracy and variability of three semi-quantitative methods for assessing right ventricular systolic function from cardiac MRI in patients with acquired heart disease. Eur Radiol. 2011;21:2111 20. 39. Maceira AM, Prasad SK, Khan M, et al. Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J. 2006;27:2879 88. 40. Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg. 2012;93:59 67. 41. Nesser HJ, Tkalec W, Patel AR, et al. Quantitation of right ventricular volumes and ejection fraction by three-dimensional echocardiography in patients: comparison with magnetic resonance imaging and radionuclide ventriculography. Echocardiography. 2006;23:666 80. 42. Pavlicek M, Wahl A, Rutz T, et al. Right ventricular systolic function assess- ment: rank of echocardiographic methods vs. cardiac magnetic resonance imaging. Eur J Echocardiogr. 2011;12:871 80. 43. Speiser U, Hirschberger M, Pilz G, et al. Tricuspid annular plane systolic excursion assessed using MRI for semi-quantification of right ventricular ejection fraction. Br J Radiol. 2012;85:e716 21. 44. Magne J, Girerd N, S n chal M, et al. Mitral repair versus replacement for ischemic mitral regurgitation: comparison of short-term and long-term survival. Circulation. 2009;120:S104-11. CLINICAL STATEMENTS AND GUIDELINES 45. Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replace- ment for ischemic mitral regurgitation? The Italian Study on the Treat- ment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg. 2013;145:128 39. 46. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgi- tation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128:916 24. 47. Miller DC. Ischemic mitral regurgitation redux to repair or to replace? J Thorac Cardiovasc Surg. 2001;122:1059 62. 48. Grayburn PA, Foster E, Sangli C, et al. Relationship between the mag- nitude of reduction in mitral regurgitation severity and left ventricular and left atrial reverse remodeling after MitraClip therapy. Circulation. 2013;128:1667 74. 49. Pibarot P, Delgado V, Bax JJ. MITRA-FR vs. COAPT: lessons from two tri- als with diametrically opposed results. Eur Heart J Cardiovasc Imaging. 2019;20:620 4. 50. Braun J, Bax JJ, Versteegh MI, et al. Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in isch- emic mitral regurgitation. Eur J Cardiothorac Surg. 2005;27:847 53. 51. Kim D-H, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging. 2019;12:665 77. 52. Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgita- tion: JACC review topic of the week. J Am Coll Cardiol. 2019;73:2465 76. 53. Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral re- gurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 2011;58:1474 81. 8. TRICUSPID VALVE DISEASE 8.1. Classification and Stages of TR 1. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long- term survival. J Am Coll Cardiol. 2004;43:405 9. 2. Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricus- pid regurgitation. JACC Cardiovasc Imaging. 2014;7:1185 94. 3. Lee J-W, Song J-M, Park JP, et al. Long-term prognosis of isolated signifi- cant tricuspid regurgitation. Circ J. 2010;74:375 80. 4. Bar N, Schwartz LA, Biner S, et al. Clinical outcome of isolated tricuspid regurgitation in patients with preserved left ventricular ejection fraction and pulmonary hypertension. J Am Soc Echocardiogr. 2018;31:34 41. 5. Benfari G, Antoine C, Miller WL, et al. Excess mortality associated with functional tricuspid regurgitation complicating heart failure with reduced ejection fraction. Circulation. 2019;140:196 206. 6. Wang N, Fulcher J, Abeysuriya N, et al. Tricuspid regurgitation is associ- ated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis. Eur Heart J. 2019;40:476 84. 7. Chorin E, Rozenbaum Z, Topilsky Y, et al. Tricuspid regurgitation and long- term clinical outcomes. Eur Heart J Cardiovasc Imaging. 2020;21:157 65. 8. Lin G, Nishimura RA, Connolly HM, et al. Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardio- verter-defibrillator leads. J Am Coll Cardiol. 2005;45:1672 5. 9. Chang JD, Manning WJ, Ebrille E, et al. Tricuspid valve dysfunction fol- lowing pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol. 2017;69:2331 41. 10. Paniagua D, Aldrich HR, Lieberman EH, et al. Increased prevalence of sig- nificant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol. 1998;82:1130 2, A9. 11. Park SJ, Gentry JL 3rd, Varma N, et al. Transvenous extraction of pace- maker and defibrillator leads and the risk of tricuspid valve regurgitation. JACC Clin Electrophysiol. 2018;4:1421 8. 12. Mediratta A, Addetia K, Yamat M, et al. 3D Echocardiographic location of implantable device leads and mechanism of associated tricuspid regurgi- tation. JACC Cardiovasc Imaging. 2014;7:337 47. 13. Addetia K, Harb SC, Hahn RT, et al. Cardiac implantable electronic de- vice lead-induced tricuspid regurgitation. JACC Cardiovasc Imaging. 2019;12:622 36. 14. Topilsky Y, Khanna A, Le Tourneau T, et al. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmo- nary hypertension. Circ Cardiovasc Imaging. 2012;5:314 23. 15. Mutlak D, Lessick J, Reisner SA, et al. Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation. J Am Soc Echocardiogr. 2007;20:405 8. 16. Zhao SX, Soltanzad N, Swaminathan A, et al. Frequency and associat- ed clinical features of functional tricuspid regurgitation in patients with chronic atrial fibrillation. Am J Cardiol. 2017;119:1371 7. 17. Utsunomiya H, Itabashi Y, Mihara H, et al. Functional tricuspid regur- gitation caused by chronic atrial fibrillation: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging. 2017;10:e004897. 18. Yamasaki N, Kondo F, Kubo T, et al. Severe tricuspid regurgitation in the aged: atrial remodeling associated with long-standing atrial fibrillation. J Cardiol. 2006;48:315 23. 19. Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to re- nal dysfunction in patients with heart failure. J Card Fail. 2008;14:824 30. 20. Lau GT, Tan HC, Kritharides L. Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation. Am J Cardiol. 2002;90:1405 9. 21. Mangoni AA, DiSalvo TG, Vlahakes GJ, et al. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg. 2001;19:68 73. 22. Kim JB, Jung S-H, Choo SJ, et al. Surgical outcomes of severe tricuspid re- gurgitation: predictors of adverse clinical outcomes. Heart. 2013;99:181 7. 23. Ailawadi G, Lapar DJ, Swenson BR, et al. Model for end-stage liver dis- ease predicts mortality for tricuspid valve surgery. Ann Thorac Surg. 2009;87:1460 7. 8.2. Tricuspid Regurgitation 8.2.1. Diagnosis of TR 1. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninva- sive evaluation of native valvular regurgitation: a report from the Ameri- can Society of Echocardiography. Developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303 71. 2. Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocar- diography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echo- cardiogr. 2010;11:307 32. 3. Nishimura RA, Carabello BA. Hemodynamics in the cardiac catheterization laboratory of the 21st century. Circulation. 2012;125:2138 50. 4. Hahn RT. Finding concordance in discord: the value of discordant invasive and echocardiographic pulmonary artery pressure measurements with se- vere tricuspid regurgitation. Eur Heart J. 2020;41:2796 8. 5. Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgita- tion and implications for transcatheter tricuspid valve repair. Eur Heart J. 2020;41:2785 95. 6. Hahn RT, Thomas JD, Khalique OK, et al. Imaging assessment of tricuspid regurgitation severity. JACC Cardiovasc Imaging. 2019;12:469 90. 7. Dahou A, Ong G, Hamid N, et al. Quantifying tricuspid regurgitation se- verity: a comparison of proximal isovelocity surface area and novel quan- titative Doppler methods. JACC Cardiovasc Imaging. 2019;12:560 2. 8. Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging. 2017;18:1342 3. 9. Peri Y, Sadeh B, Sherez C, et al. Quantitative assessment of effective re- gurgitant orifice: impact on risk stratification, and cut-off for severe and torrential tricuspid regurgitation grade. Eur Heart J Cardiovasc Imaging. 2019;21:768 76. 10. Utsunomiya H, Harada Y, Susawa H, et al. Comprehensive evaluation of tricuspid regurgitation location and severity using vena contracta analysis: a color Doppler three-dimensional transesophageal echocardiographic study. J Am Soc Echocardiogr. 2019;32:1526 37.e2. 11. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for eval- uation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777 802. 12. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocardiogra- phy and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol. 1989;14:1266 74. 13. Dreyfus GD, Corbi PJ, Chan KMJ, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79:127 32. 14. Lancellotti P, Tribouilloy C, Hagendorff A, et al. European Association of Echocardiography recommendations for the assessment of valvular regur- gitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:223 44. 15. Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treat- ment for functional tricuspid regurgitation with regurgitant volume: CLINICAL STATEMENTS AND GUIDELINES characteristic differences based on primary cardiac lesion. J Thorac Car- diovasc Surg. 1999;117:463 71. 16. Ling LF, Obuchowski NA, Rodriguez L, et al. Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr. 2012;25:709 13. 17. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685 713. 8.2.2. Medical Therapy 1. Antoniou T, Koletsis EN, Prokakis C, et al. Hemodynamic effects of com- bination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. J Cardiothorac Vasc Anesth. 2013;27:459 66. 2. McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consen- sus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association. Developed in collaboration with the Ameri- can College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009;53:1573 619. 3. Wang J, Han J, Li Y, et al. Impact of surgical ablation of atrial fibrillation on the progression of tricuspid regurgitation and right-sided heart remodel- ing after mitral-valve surgery: a propensity-score matching analysis. J Am Heart Assoc. 2016;5:e004213. 4. Stulak JM, Schaff HV, Dearani JA, et al. Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. Ann Thorac Surg. 2008;86:40 4; discussion 44 5. 8.2.3. Timing of Intervention 1. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: anal- ysis of outcome in 34 patients. J Heart Valve Dis. 1999;8:567 74. 2. Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg. 2012;143:1043 9. 3. Dreyfus GD, Corbi PJ, Chan KMJ, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79:127 32. 4. Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg. 2012;93:59 67. 5. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annulo- plasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg. 2012;143:632 8. 6. Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg. 2011;141:1431 9. 7. Calafiore AM, Gallina S, Iac AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? A propensity score analysis. Ann Thorac Surg. 2009;87:698 703. 8. Chan V, Burwash IG, Lam B-K, et al. Clinical and echocardiographic im- pact of functional tricuspid regurgitation repair at the time of mitral valve replacement. Ann Thorac Surg. 2009;88:1209 15. 9. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid re- gurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardio- graphic outcomes. Heart. 2012;98:24 30. 10. Yilmaz O, Suri RM, Dearani JA, et al. Functional tricuspid regurgitation at the time of mitral valve repair for degenerative leaflet prolapse: the case for a selective approach. J Thorac Cardiovasc Surg. 2011;142:608 13. 11. Hamandi M, Smith RL, Ryan WH, et al. Outcomes of isolated tricus- pid valve surgery have improved in the modern era. Ann Thorac Surg. 2019;108:11 5. 12. Kim Y-J, Kwon D-A, Kim H-K, et al. Determinants of surgical outcome in pa- tients with isolated tricuspid regurgitation. Circulation. 2009;120:1672 8. 13. Messika-Zeitoun D, Thomson H, Bellamy M, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Car- diovasc Surg. 2004;128:296 302. 14. M ller JE, Pellikka PA, Bernheim AM, et al. Prognosis of carcinoid heart disease: analysis of 200 cases over two decades. Circulation. 2005;112:3320 7. 15. Kadri AN, Menon V, Sammour YM, et al. Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart. 2019;105:1813 7. 16. Lee J-W, Song J-M, Park JP, et al. Long-term prognosis of isolated signifi- cant tricuspid regurgitation. Circ J. 2010;74:375 80. 17. Axtell AL, Bhambhani V, Moonsamy P, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74:715 25. 18. Pfannm ller B, Misfeld M, Borger MA, et al. Isolated reoperative minimally invasive tricuspid valve operations. Ann Thorac Surg. 2012;94:2005 10. 19. Kim JB, Jung S-H, Choo SJ, et al. Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation. J Thorac Cardio- vasc Surg. 2013;146:278 84. 20. Mangoni AA, DiSalvo TG, Vlahakes GJ, et al. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg. 2001;19:68 73. 21. Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol. 2017;70:2953 60. 22. Topilsky Y, Khanna AD, Oh JK, et al. Preoperative factors associated with adverse outcome after tricuspid valve replacement. Circulation. 2011;123:1929 39. 23. Fender EA, Petrescu I, Ionescu F, et al. Prognostic importance and pre- dictors of survival in isolated tricuspid regurgitation: a growing problem. Mayo Clin Proc. 2019;94:2032 9. 24. Topilsky Y, Khanna A, Le Tourneau T, et al. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmo- nary hypertension. Circ Cardiovasc Imaging. 2012;5:314 23. 25. Mutlak D, Lessick J, Reisner SA, et al. Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation. J Am Soc Echocardiogr. 2007;20:405 8. 26. Taramasso M, Hahn RT, Alessandrini H, et al. The international multicenter TriValve registry: which patients are undergoing transcatheter tricuspid re- pair? JACC Cardiovasc Interv. 2017;10:1982 90. 27. Asmarats L, Puri R, Latib A, et al. Transcatheter tricuspid valve interven- tions: landscape, challenges, and future directions. J Am Coll Cardiol. 2018;71:2935 56. 28. Chikwe J, Anyanwu AC. Surgical strategies for functional tricuspid regur- gitation. Semin Thorac Cardiovasc Surg. 2010;22:90 6. 29. Kwon D-A, Park J-S, Chang H-J, et al. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity. Am J Cardiol. 2006;98:659 61. 30. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91:677 84. 31. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718 25. 32. Kwak J-J, Kim Y-J, Kim M-K, et al. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long- term echocardiographic examinations. Am Heart J. 2008;155:732 7. 33. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocardiogra- phy and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol. 1989;14:1266 74. 34. Mahesh B, Wells F, Nashef S, et al. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery. Eur J Cardiothorac Surg. 2013;43:2 8. 35. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol. 2009;53:401 8. 36. Sagie A, Schwammenthal E, Padial LR, et al. Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients. J Am Coll Cardiol. 1994;24:446 53. 37. Lin G, Nishimura RA, Connolly HM, et al. Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardio- verter-defibrillator leads. J Am Coll Cardiol. 2005;45:1672 5. 38. Alqahtani F, Berzingi CO, Aljohani S, et al. Contemporary trends in the use and outcomes of surgical treatment of tricuspid regurgitation. J Am Heart Assoc. 2017;6:e007597. 39. Jeganathan R, Armstrong S, Al-Alao B, et al. The risk and outcomes of reoperative tricuspid valve surgery. Ann Thorac Surg. 2013;95:119 24. 9. PULMONIC VALVE DISEASE 1. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the CLINICAL STATEMENTS AND GUIDELINES American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e698 800. 10. MIXED VALVE DISEASE 10.1. Diagnosis of Mixed VHD 1. Unger P, Rosenhek R, Dedobbeleer C, et al. Management of multiple valve disease. Heart. 2011;97:272 7. 2. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91:677 84. 3. Venneri L, Khattar RS, Senior R. Assessment of complex multi-valve dis- ease and prosthetic valves. Heart Lung Circ. 2019;28:1436 46. 4. Iung B, Delgado V, Rosenhek R, et al. Contemporary presentation and management of valvular heart disease: the EURObservational Research Pro- gramme Valvular Heart Disease II Survey. Circulation. 2019;140:1156 69. 5. Unger P, Clavel MA, Lindman BR, et al. Pathophysiology and management of multivalvular disease. Nat Rev Cardiol. 2016;13:429 40. 10.2. Timing of Intervention for Mixed VHD 10.2.1. Intervention for Mixed AS and AR 1. Zilberszac R, Gabriel H, Schemper M, et al. Outcome of combined stenotic and regurgitant aortic valve disease. J Am Coll Cardiol. 2013;61:1489 95. 2. Egbe AC, Luis SA, Padang R, et al. Outcomes in moderate mixed aor- tic valve disease: is it time for a paradigm shift? J Am Coll Cardiol. 2016;67:2321 9. 10.2.2. Intervention for Mixed AS and MR 1. Gillinov AM, Blackstone EH, Cosgrove DM 3rd, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003;125:1372 87. 2. Nombela-Franco L, Ribeiro HB, Urena M, et al. Significant mitral regurgita- tion left untreated at the time of aortic valve replacement: a comprehen- sive review of a frequent entity in the transcatheter aortic valve replace- ment era. J Am Coll Cardiol. 2014;63:2643 58. 3. Kiramijyan S, Koifman E, Asch FM, et al. Impact of functional versus or- ganic baseline mitral regurgitation on short- and long-term outcomes af- ter transcatheter aortic valve replacement. Am J Cardiol. 2016;117:839 46. 4. Chakravarty T, Van Belle E, Jilaihawi H, et al. Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve im- plantation. Am J Cardiol. 2015;115:942 9. 5. Cort s C, Amat-Santos IJ, Nombela-Franco L, et al. Mitral regurgitation af- ter transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv. 2016;9:1603 14. 6. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutane- ous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66:2844 54. 7. Jeong DS, Park PW, Sung K, et al. Long-term clinical impact of functional mitral regurgitation after aortic valve replacement. Ann Thorac Surg. 2011;92:1339 45. 8. Ruel M, Kapila V, Price J, et al. Natural history and predictors of outcome in patients with concomitant functional mitral regurgitation at the time of aortic valve replacement. Circulation. 2006;114:I541 6. 9. Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moder- ate/severe mitral regurgitation on 2-year outcome after transcath- eter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A. Circulation. 2013;128:2776 84. 10. Abdelghani M, Abdel-Wahab M, Hemetsberger R, et al. Fate and long- term prognostic implications of mitral regurgitation in patients undergo- ing transcatheter aortic valve replacement. Int J Cardiol. 2019;288:39 43. 10.2.4. Intervention for Mixed MS and AR 1. Gash AK, Carabello BA, Kent RL, et al. Left ventricular performance in patients with coexistent mitral stenosis and aortic insufficiency. J Am Coll Cardiol. 1984;3:703 11. 2. Unger P, Pibarot P, Tribouilloy C, et al. Multiple and mixed valvular heart diseases. Circ Cardiovasc Imaging. 2018;11:e007862. 3. Gillinov AM, Blackstone EH, Cosgrove DM 3rd, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003;125:1372 87. 11. PROSTHETIC VALVES 11.1. Evaluation and Selection of Prosthetic Valves 11.1.1. Diagnosis and Follow-Up of Prosthetic Valves 1. Burstow DJ, Nishimura RA, Bailey KR, et al. Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients. A simulta- neous Doppler-catheter correlative study. Circulation. 1989;80:504 14. 2. Baumgartner H, Khan S, DeRobertis M, et al. Effect of prosthetic aortic valve design on the Doppler-catheter gradient correlation: an in vitro study of normal St. Jude, Medtronic-Hall, Starr-Edwards and Hancock valves. J Am Coll Cardiol. 1992;19:324 32. 3. Vandervoort PM, Greenberg NL, Powell KA, et al. Pressure recovery in bileaflet heart valve prostheses. Localized high velocities and gradients in central and side orifices with implications for Doppler-catheter gradient relation in aortic and mitral position. Circulation. 1995;92:3464 72. 4. Dumesnil JG, Honos GN, Lemieux M, et al. Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiog- raphy. J Am Coll Cardiol. 1990;16:637 43. 5. Van den Brink RBA. Evaluation of prosthetic heart valves by transesopha- geal echocardiography: problems, pitfalls, and timing of echocardiogra- phy. Semin Cardiothorac Vasc Anesth. 2006;10:89 100. 6. Vitarelli A, Conde Y, Cimino E, et al. Assessment of severity of mechani- cal prosthetic mitral regurgitation by transoesophageal echocardiography. Heart. 2004;90:539 44. 7. Kronzon I, Sugeng L, Perk G, et al. Real-time 3-dimensional trans- esophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol. 2009;53:1543 7. 8. Kim JY, Suh YJ, Han K, et al. Diagnostic value of advanced imaging mo- dalities for the detection and differentiation of prosthetic valve obstruc- tion: a systematic review and meta-analysis. JACC Cardiovasc Imaging. 2019;12:2182 92. 9. Salaun E, Mahjoub H, Girerd N, et al. Rate, timing, correlates, and out- comes of hemodynamic valve deterioration after bioprosthetic surgical aortic valve replacement. Circulation. 2018;138:971 85. 10. Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol. 2010;55:2413 26. 11. van Geldorp MWA, Eric Jamieson WR, Kappetein AP, et al. Patient out- come after aortic valve replacement with a mechanical or biological pros- thesis: weighing lifetime anticoagulant-related event risk against reopera- tion risk. J Thorac Cardiovasc Surg. 2009;137:881 6, 866.e1 5. 12. Salaun E, Mahjoub H, Dahou A, et al. Hemodynamic deterioration of surgically implanted bioprosthetic aortic valves. J Am Coll Cardiol. 2018;72:241 51. 13. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of struc- tural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388 99. 14. Douglas PS, Leon MB, Mack MJ, et al. Longitudinal hemodynamics of transcatheter and surgical aortic valves in the PARTNER trial. JAMA Car- diol. 2017;2:1197 206. 15. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aor- tic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385:2477 84. 16. Kapadia SR, Leon MB, Makkar RR, et al. 5-Year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385:2485 91. 17. Fernandez-Santos S, Th ron A, Pibarot P, et al. Valve hemodynamic per- formance and myocardial strain after implantation of a third-generation, balloon-expandable, transcatheter aortic valve. Cardiol J. 2019 May 20. Online ahead of print. doi:10.5603/CJ.a2019.0049 18. Manoharan G, Van Mieghem NM, Windecker S, et al. 1-Year outcomes with the Evolut R self-expanding transcatheter aortic valve: from the inter- national FORWARD study. JACC Cardiovasc Interv. 2018;11:2326 34. CLINICAL STATEMENTS AND GUIDELINES 19. Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year outcomes of self-ex- panding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol. 2018;72:2687 96. 20. Blackman DJ, Saraf S, MacCarthy PA, et al. Long-term durability of trans- catheter aortic valve prostheses. J Am Coll Cardiol. 2019;73:537 45. 21. S ndergaard L, Ihlemann N, Capodanno D, et al. Durability of transcath- eter and surgical bioprosthetic aortic valves in patients at lower surgical risk. J Am Coll Cardiol. 2019;73:546 53. 11.2.1. Selection of Prosthetic Valve Type: Bioprosthetic Versus Mechanical Valve 1. Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic pros- theses for aortic-valve and mitral-valve replacement. N Engl J Med. 2017;377:1847 57. 2. Badhwar V, Ofenloch JC, Rovin JD, et al. Noninferiority of closely moni- tored mechanical valves to bioprostheses overshadowed by early mortality benefit in younger patients. Ann Thorac Surg. 2012;93:748 53. 3. Brown ML, Schaff HV, Lahr BD, et al. Aortic valve replacement in patients aged 50 to 70 years: improved outcome with mechanical versus biologic prostheses. J Thorac Cardiovasc Surg. 2008;135:878 84. 4. van Geldorp MWA, Eric Jamieson WR, Kappetein AP, et al. Patient out- come after aortic valve replacement with a mechanical or biological pros- thesis: weighing lifetime anticoagulant-related event risk against reopera- tion risk. J Thorac Cardiovasc Surg. 2009;137:881 6, 866.e1 5. 5. Kulik A, B dard P, Lam B-K, et al. Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur J Cardiothorac Surg. 2006;30:485 91. 6. Glaser N, Jackson V, Holzmann MJ, et al. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50 69 years. Eur Heart J. 2016;37:2658 67. 7. Chikwe J, Chiang YP, Egorova NN, et al. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA. 2015;313:1435 42. 8. McClure RS, McGurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis. J Thorac Cardiovasc Surg. 2014;148:1931 9. 9. Chiang YP, Chikwe J, Moskowitz AJ, et al. Survival and long-term out- comes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA. 2014;312:1323 9. 10. Kaneko T, Aranki S, Javed Q, et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg. 2014;147:117 26. 11. Bourguignon T, Bouquiaux-Stablo A-L, Loardi C, et al. Very late outcomes for mitral valve replacement with the Carpentier-Edwards pericardial bio- prosthesis: 25-year follow-up of 450 implantations. J Thorac Cardiovasc Surg. 2014;148:2004 11.e1. 12. Buratto E, Shi WY, Wynne R, et al. Improved survival after the Ross pro- cedure compared with mechanical aortic valve replacement. J Am Coll Cardiol. 2018;71:1337 44. 13. El-Hamamsy I, Eryigit Z, Stevens L-M, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Lancet. 2010;376:524 31. 14. Martin E, Mohammadi S, Jacques F, et al. Clinical outcomes following the Ross procedure in adults: a 25-year longitudinal study. J Am Coll Cardiol. 2017;70:1890 9. 15. Bourguignon T, El Khoury R, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards PERIMOUNT aortic valve in patients aged 60 or younger. Ann Thorac Surg. 2015;100:853 9. 16. Tuzcu EM, Kapadia SR, Vemulapalli S, et al. Transcatheter aortic valve re- placement of failed surgically implanted bioprostheses: the STS/ACC reg- istry. J Am Coll Cardiol. 2018;72:370 82. 17. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve- in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv. 2015;8:1735 44. 18. Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312:162 70. 19. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in- valve registry. Circulation. 2012;126:2335 44. 20. Coylewright M, Forrest JK, McCabe JM, et al. TAVR in low-risk patients: FDA approval, the new NCD, and shared decision-making. J Am Coll Car- diol. 2020;75:1208 11. 21. Hess EP, Coylewright M, Frosch DL, et al. Implementation of shared deci- sion making in cardiovascular care: past, present, and future. Circ Cardio- vasc Qual Outcomes. 2014;7:797 803. 22. Weber A, Noureddine H, Englberger L, et al. Ten-year comparison of peri- cardial tissue valves versus mechanical prostheses for aortic valve replace- ment in patients younger than 60 years of age. J Thorac Cardiovasc Surg. 2012;144:1075 83. 23. Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152 8. 24. Chan V, Jamieson WRE, Germann E, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related com- plications to 15 years after aortic valve replacement. J Thorac Cardiovasc Surg. 2006;131:1267 73. 25. Dunning J, Gao H, Chambers J, et al. Aortic valve surgery: marked in- creases in volume and significant decreases in mechanical valve use an analysis of 41,227 patients over 5 years from the Society for Cardiotho- racic Surgery in Great Britain and Ireland National database. J Thorac Car- diovasc Surg. 2011;142:776 82.e3. 26. Stassano P, L. DT, Monaco M, et al. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol. 2009;54:1862 8. 27. Brennan JM, Edwards FH, Zhao Y, et al. Long-term safety and effective- ness of mechanical versus biologic aortic valve prostheses in older pa- tients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Circulation. 2013;127:1647 55. 28. Banbury MK, Cosgrove DM 3rd, Thomas JD, et al. Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg. 2002;73:1460 5. 29. Dellgren G, David TE, Raanani E, et al. Late hemodynamic and clinical out- comes of aortic valve replacement with the Carpentier-Edwards Perimount pericardial bioprosthesis. J Thorac Cardiovasc Surg. 2002;124:146 54. 30. Borger MA, Ivanov J, Armstrong S, et al. Twenty-year results of the Han- cock II bioprosthesis. J Heart Valve Dis. 2006;15:49 55. 31. Myk n PSU, Bech-Hansen O. A 20-year experience of 1712 patients with the Biocor porcine bioprosthesis. J Thorac Cardiovasc Surg. 2009;137:76 81. 32. Mazine A, El-Hamamsy I, Verma S, et al. Ross procedure in adults for car- diologists and cardiac surgeons: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72:2761 77. 11.2. Antithrombotic Therapy 1. Cannegieter SC, Rosendaal FR, Bri t E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circula- tion. 1994;89:635 41. 2. Cannegieter SC, Rosendaal FR, Wintzen AR, et al. Optimal oral antico- agulant therapy in patients with mechanical heart valves. N Engl J Med. 1995;333:11 7. 3. Sun JCJ, Davidson MJ, Lamy A, et al. Antithrombotic management of pa- tients with prosthetic heart valves: current evidence and future trends. Lancet. 2009;374:565 76. 4. Van de Werf F, Brueckmann M, Connolly SJ, et al. A comparison of dabig- atran etexilate with warfarin in patients with mechanical heart valves: the Randomized, phase II study to Evaluate the sAfety and pharmacokinetics of oraL dabIGatran etexilate in patients after heart valve replacemeNt (RE- ALIGN). Am Heart J. 2012;163:931 7.e1. 5. Eikelboom JW, Connolly SJ, Brueckmann M, et al. Dabigatran ver- sus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206 14. 6. Torella M, Torella D, Chiodini P, et al. 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Meta-analysis comparing single versus dual antiplatelet therapy following transcatheter aortic valve implanta- tion. Am J Cardiol. 2018;122:310 5. 15. Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25:1111 9. 16. Colli A, Mestres CA, Castella M, et al. Comparing warfarin to aspirin (WoA) after aortic valve replacement with the St. Jude Medical Epic heart valve bioprosthesis: results of the WoA Epic pilot trial. J Heart Valve Dis. 2007;16:667 71. 17. Aramendi JI, Mestres C-A, Martinez-Le n J, et al. Triflusal versus oral an- ticoagulation for primary prevention of thromboembolism after biopros- thetic valve replacement (TRAC): prospective, randomized, co-operative trial. Eur J Cardiothorac Surg. 2005;27:854 60. 18. Nu ez L, Gil Aguado M, Larrea JL, et al. Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis. Ann Thorac Surg. 1984;37:84 7. 19. 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Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement? J Thorac Cardio- vasc Surg. 2005;129:1024 31. 25. El Bardissi AW, DiBardino DJ, Chen FY, et al. Is early antithrombotic ther- apy necessary in patients with bioprosthetic aortic valves in normal sinus rhythm? J Thorac Cardiovasc Surg. 2010;139:1137 45. 26. Massel DR, Little SH. Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev. 2013;CD003464. 27. Puskas J, Gerdisch M, Nichols D, et al. Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospec- tive randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial. J Thorac Cardiovasc Surg. 2014;147:1202 10. 28. Puskas JD, Gerdisch M, Nichols D, et al. Anticoagulation and antiplatelet strategies after On-X mechanical aortic valve replacement. J Am Coll Car- diol. 2018;71:2717 26. 29. 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Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139 51. 35. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093 104. 36. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in non- valvular atrial fibrillation. N Engl J Med. 2011;365:883 91. 37. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981 92. 38. Edmunds LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg. 1987;44:430 45. 39. Capodanno D, Angiolillo DJ. Antiplatelet therapy after implantation of bioresorbable vascular scaffolds: a review of the published data, practi- cal recommendations, and future directions. JACC Cardiovasc Interv. 2017;10:425 37. 40. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagu- lation in patients with atrial fibrillation. N Engl J Med. 2015;373:823 33. 11.3. Bridging Therapy 1. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative manage- ment of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines. Chest. 2012;141:e326S 50S. 2. Kearon C, Hirsh J. Management of anticoagulation before and after elec- tive surgery. N Engl J Med. 1997;336:1506 11. 3. Tinker JH, Tarhan S. Discontinuing anticoagulant therapy in surgical pa- tients with cardiac valve prostheses. Observations in 180 operations. JAMA. 1978;239:738 9. 4. Lankiewicz MW, Hays J, Friedman KD, et al. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost. 2006;4:967 70. 5. Renda G, Ricci F, Giugliano RP, et al. Non-vitamin K antagonist oral antico- agulants in patients with atrial fibrillation and valvular heart disease. J Am Coll Cardiol. 2017;69:1363 71. 6. Hammerstingl C, Tripp C, Schmidt H, et al. Periprocedural bridging ther- apy with low-molecular-weight heparin in chronically anticoagulated pa- tients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. J Heart Valve Dis. 2007;16:285 92. 7. Spyropoulos AC, Turpie AG, Dunn AS, et al. Perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin in patients with mechanical prosthetic heart valves on long-term oral anticoagulants (from the REGIMEN Registry). Am J Cardiol. 2008;102:883 9. 8. Pengo V, Cucchini U, Denas G, et al. Standardized low-molecular-weight heparin bridging regimen in outpatients on oral anticoagulants undergo- ing invasive procedure or surgery: an inception cohort management study. Circulation. 2009;119:2920 7. 9. Daniels PR, McBane RD, Litin SC, et al. Peri-procedural anticoagulation management of mechanical prosthetic heart valve patients. Thromb Res. 2009;124:300 5. 10. Bui HT, Krisnaswami A, Le CU, et al. Comparison of safety of subcutane- ous enoxaparin as outpatient anticoagulation bridging therapy in patients with a mechanical heart valve versus patients with nonvalvular atrial fibril- lation. Am J Cardiol. 2009;104:1429 33. 11. Biteker M, Tekkesin AI, Can MM, et al. Outcome of noncardiac and non- vascular surgery in patients with mechanical heart valves. Am J Cardiol. 2012;110:562 7. 12. Weiss A, Brose S, Ploetze K, et al. Half-dose enoxaparin vs. full-dose enoxaparin for postoperative bridging therapy in patients after cardiac surgery: which dose regimen should be preferred? Clin Hemorheol Micro- circ. 2013;54:249 58. 13. Pengo V, Palareti G, Cucchini U, et al. Low-intensity oral anticoagulant plus low-dose aspirin during the first six months versus standard-intensity oral anticoagulant therapy after mechanical heart valve replacement: a pilot study of low-intensity warfarin and aspirin in cardiac prostheses (LI- WACAP). Clin Appl Thromb Hemost. 2007;13:241 8. 14. Hjellstrom L, Labaf A. Prophylactic doses of low-molecular weight hepa- rin as periprocedural bridging therapy in mechanical heart valve patients. Thromb Res. 2018;163:180 4. 15. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridg- ing anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823 33. CLINICAL STATEMENTS AND GUIDELINES 11.4. Excessive Anticoagulation and Serious Bleeding With Prosthetic Valves 1. Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511 20. 2. Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015;373:2413 24. 3. Connolly SJ, Milling TJ Jr, Eikelboom JW, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med. 2016;375:1131 41. 4. Connolly SJ, Crowther M, Eikelboom JW, et al. Full study report of andex- anet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380:1326 35. 5. Pollack CV Jr, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran rever- sal - full cohort analysis. N Engl J Med. 2017;377:431 41. 6. Genewein U, Haeberli A, Straub PW, et al. Rebound after cessation of oral anticoagulant therapy: the biochemical evidence. Br J Haematol. 1996;92:479 85. 7. Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral antico- agulants: a report of the American College of Cardiology Task Force on Ex- pert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70:3042 67. 8. Tazarourte K, Riou B, Tremey B, et al. Guideline-concordant administra- tion of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K an- tagonist treatment (EPAHK study). Crit Care. 2014;18:R81. 9. Tsu LV, Dienes JE, Dager WE. Vitamin K dosing to reverse warfarin based on INR, route of administration, and home warfarin dose in the acute/ critical care setting. Ann Pharmacother. 2012;46:1617 26. 10. Pernod G, Godi r A, Gozalo C, et al. French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situ- ations (overdose, risk of bleeding, and active bleeding). Thromb Res. 2010;126:e167 74. 11. Weibert RT, Le DT, Kayser SR, et al. Correction of excessive anticoagulation with low-dose oral vitamin K1. Ann Intern Med. 1997;126:959 62. 12. Yiu K-H, Siu C-W, Jim M-H, et al. Comparison of the efficacy and safety profiles of intravenous vitamin K and fresh frozen plasma as treatment of warfarin-related over-anticoagulation in patients with mechanical heart valves. Am J Cardiol. 2006;97:409 11. 13. Khatib R, Ludwikowska M, Witt DM, et al. Vitamin K for reversal of exces- sive vitamin K antagonist anticoagulation: a systematic review and meta- analysis. Blood Adv. 2019;3:789 96. 11.5. Thromboembolic Events With Prosthetic Valves 1. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 2. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 3. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet throm- bosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015 24. 4. Sondergaard L, De Backer O, Kofoed KF, et al. Natural history of subclini- cal leaflet thrombosis affecting motion in bioprosthetic aortic valves. Eur Heart J. 2017;38:2201 7. 11.6. Acute Mechanical Valve Thrombosis 11.6.1. Diagnosis of Acute Mechanical Valve Thrombosis 1. Montorsi P, De Bernardi F, Muratori M, et al. Role of cine-fluoroscopy, transthoracic, and transesophageal echocardiography in patients with sus- pected prosthetic heart valve thrombosis. Am J Cardiol. 2000;85:58 64. 2. Muratori M, Montorsi P, Teruzzi G, et al. Feasibility and diagnostic ac- curacy of quantitative assessment of mechanical prostheses leaflet mo- tion by transthoracic and transesophageal echocardiography in suspected prosthetic valve dysfunction. Am J Cardiol. 2006;97:94 100. 3. Cianciulli TE, Lax JA, Beck MA, et al. Cinefluoroscopic assessment of me- chanical disc prostheses: its value as a complementary method to echocar- diography. J Heart Valve Dis. 2005;14:664 73. 4. Symersky P, Budde RPJ, de Mol BAJM, et al. Comparison of multidetector- row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol. 2009;104:1128 34. 5. Bapat V, Attia R, Redwood S, et al. Use of transcatheter heart valves for a valve-in-valve implantation in patients with degenerated aortic biopros- thesis: technical considerations and results. J Thorac Cardiovasc Surg. 2012;144:1372 9. 6. G nd z S, zkan M, Kal ik M, et al. Sixty-four-section cardiac computed tomography in mechanical prosthetic heart valve dysfunction: thrombus or pannus. Circ Cardiovasc Imaging. 2015;8:e003246. 7. Suh YJ, Lee S, Im DJ, et al. Added value of cardiac computed tomog- raphy for evaluation of mechanical aortic valve: emphasis on evaluation of pannus with surgical findings as standard reference. Int J Cardiol. 2016;214:454 60. 8. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 9. Barbetseas J, Nagueh SF, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evalu- ation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410 7. 10. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation 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. J Am Soc Echocardiogr. 2009;22:975 1014. 11. zkan M, G nd z S, Biteker M, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging. 2013;6:206 16. 12. Such D, Symersky P, Tanis W, et al. Multimodality imaging assessment of prosthetic heart valves. Circ Cardiovasc Imaging. 2015;8:e003703. 1. C ceres-L riga FM, P rez-L pez H, Morlans-Hern ndez K, et al. Throm- bolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients. J Thromb Thrombolysis. 2006;21:185 90. 2. Karthikeyan G, Senguttuvan NB, Joseph J, et al. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies. Eur Heart J. 2013;34:1557 66. 3. Keuleers S, Herijgers P, Herregods M-C, et al. Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis. Am J Cardiol. 2011;107:275 9. 4. Nagy A, D nes M, Lengyel M. Predictors of the outcome of thrombolytic therapy in prosthetic mitral valve thrombosis: a study of 62 events. J Heart Valve Dis. 2009;18:268 75. 5. zkan M, akal B, Karakoyun S, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low- dose, slow infusion of tissue-type plasminogen activator. Circulation. 2013;128:532 40. 6. zkan M, G nd z S, Biteker M, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging. 2013;6:206 16. 7. Roudaut R, Lafitte S, Roudaut M-F, et al. Management of prosthetic heart valve obstruction: fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases. Arch Cardiovasc Dis. 2009;102:269 77. 8. Tong AT, Roudaut R, Ozkan M, et al. Transesophageal echocardiogra- phy improves risk assessment of thrombolysis of prosthetic valve throm- bosis: results of the international PRO-TEE registry. J Am Coll Cardiol. 2004;43:77 84. 9. Bade AS, Shaikh SSA, Khemani H, et al. Thrombolysis is an effective and safe therapy in stuck mitral valves with delayed presentation as well as hemodynamically unstable patients: a single centre study. Cardiol Res. 2018;9:161 4. 10. Pragt H, van Melle JP, Javadikasgari H, et al. Mechanical valves in the pul- monary position: an international retrospective analysis. J Thorac Cardio- vasc Surg. 2017;154:1371 8.e1. CLINICAL STATEMENTS AND GUIDELINES 11. Taherkhani M, Hashemi SR, Hekmat M, et al. Thrombolytic therapy for right-sided mechanical pulmonic and tricuspid valves: the largest survival analysis to date. Tex Heart Inst J. 2015;42:543 7. 12. Kumar BM, Gnanaraj JP, Swaminathan N, et al. Assessment of hemody- namic and clinical response in thrombolytic therapy for prosthetic valve thrombosis. Indian Heart J. 2017;69:S6. 13. zkan M, G nd z S, G rsoy OM, et al. Ultraslow thrombolytic therapy: a novel strategy in the management of PROsthetic MEchanical valve Throm- bosis and the prEdictors of outcomE: the Ultra-slow PROMETEE trial. Am Heart J. 2015;170:409 18. 14. Roudaut R, Lafitte S, Roudaut M-F, et al. Fibrinolysis of mechanical pros- thetic valve thrombosis: a single-center study of 127 cases. J Am Coll Cardiol. 2003;41:653 8. 11.7. Bioprosthetic Valve Thrombosis 11.7.1. Diagnosis of Bioprosthetic Valve Thrombosis 1. Puri R, Auffret V, Rod s-Cabau J. Bioprosthetic valve thrombosis. J Am Coll Cardiol. 2017;69:2193 211. 2. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al. Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta- analysis and microsimulation. Circulation. 2001;103:1535 41. 3. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 4. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 5. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 6. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. 11.7.2. Medical Therapy 1. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet throm- bosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015 24. 2. Jander N, Kienzle R-P, Kayser G, et al. Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position. Am J Cardiol. 2012;109:257 62. 3. Butnaru A, Shaheen J, Tzivoni D, et al. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation. Am J Cardiol. 2013;112:1439 44. 4. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. 5. De Marchena E., Mesa J, Pomenti S, et al. Thrombus formation fol- lowing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2015;8:728 39. 6. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 7. Latib A, Naganuma T, Abdel-Wahab M, et al. Treatment and clinical out- comes of transcatheter heart valve thrombosis. Circ Cardiovasc Interv. 2015;8:e001779. 8. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 11.8. Prosthetic Valve Stenosis 11.8.1. Diagnosis of Prosthetic Valve Stenosis 1. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation 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. J Am Soc Echocardiogr. 2009;22:975 1014. 2. Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the im- aging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:589 90. 3. Puri R, Auffret V, Rod s-Cabau J. Bioprosthetic valve thrombosis. J Am Coll Cardiol. 2017;69:2193 211. 4. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al. Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta- analysis and microsimulation. Circulation. 2001;103:1535 41. 5. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 6. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 7. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 8. Barbetseas J, Nagueh SF, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evalu- ation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410 7. 9. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of struc- tural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388 99. 10. Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034 48. 11. Koene BM, Soliman Hamad MA, Bouma W, et al. Impact of prosthesis- patient mismatch on early and late mortality after aortic valve replace- ment. J Cardiothorac Surg. 2013;8:96. 11.8.2. Intervention for Prosthetic Valve Stenosis 1. Leontyev S, Borger MA, Davierwala P, et al. Redo aortic valve surgery: early and late outcomes. Ann Thorac Surg. 2011;91:1120 6. 2. Kaneko T, Vassileva CM, Englum B, et al. Contemporary outcomes of re- peat aortic valve replacement: a benchmark for transcatheter valve-in- valve procedures. Ann Thorac Surg. 2015;100:1298 304. 3. Jaussaud N, Gariboldi V, Grisoli D, et al. Risk of reoperation for mitral bioprosthesis dysfunction. J Heart Valve Dis. 2012;21:56 60. 4. Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312:162 70. 5. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve- in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv. 2015;8:1735 44. 6. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet throm- bosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015 24. 7. Jander N, Kienzle R-P, Kayser G, et al. Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position. Am J Cardiol. 2012;109:257 62. 8. Butnaru A, Shaheen J, Tzivoni D, et al. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation. Am J Cardiol. 2013;112:1439 44. 9. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. catheter aortic valve replacement. JACC Cardiovasc Interv. 2015;8:728 39. 11. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 12. Latib A, Naganuma T, Abdel-Wahab M, et al. Treatment and clinical out- comes of transcatheter heart valve thrombosis. Circ Cardiovasc Interv. 2015;8:e001779. 13. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 14. Gozdek M, Raffa GM, Suwalski P, et al. Comparative performance of transcatheter aortic valve-in-valve implantation versus conventional surgi- cal redo aortic valve replacement in patients with degenerated aortic valve CLINICAL STATEMENTS AND GUIDELINES bioprostheses: systematic review and meta-analysis. Eur J Cardiothorac Surg. 2018;53:495 504. 15. Takagi H, Hari Y, Kawai N, et al. Meta-analysis of transcatheter aortic valve implantation for bicuspid versus tricuspid aortic valves. J Cardiol. 2019;74:40 8. 16. Kaneko T, Aranki S, Javed Q, et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg. 2014;147:117 26. 17. Petrescu I, Egbe AC, Ionescu F, et al. Long-term outcomes of anticoagula- tion for bioprosthetic valve thrombosis. J Am Coll Cardiol. 2020;75:857 66. 11.9. Prosthetic Valve Regurgitation 1. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of struc- tural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388 99. 2. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation 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. J Am Soc Echocardiogr. 2009;22:975 1014. 11.9.1. 