ACC/AHA Task Force Members:
|Low risk (must meet ALL criteria in this column)||Intermediate risk (any 1 criterion in this column)||High risk (any 1 criterion in this column)||Prohibitive risk (any 1 criterion in this column)|
Seven frailty indices: Katz Activities of Daily Living (independence in feeding, bathing, dressing, transferring, toileting, and urinary continence) and independence in ambulation (no walking aid or assist required or 5-m walk in <6 s). Other scoring systems can be applied to calculate no, mild, or moderate-to-severe frailty.
|1 Index (mild)|
|≥2 Indices (moderate to severe)|
|Predicted risk with surgery of death or major morbidity (all-cause) >50% at 1 y|
|Major organ system compromise not to be improved postoperatively|
Examples of major organ system compromise: Cardiac—severe LV systolic or diastolic dysfunction or RV dysfunction, fixed pulmonary hypertension; CKD stage 3 or worse; pulmonary dysfunction with FEV1 <50% or DL co2 <50% of predicted; CNS dysfunction (dementia, Alzheimer’s disease, Parkinson’s disease, CVA with persistent physical limitation); GI dysfunction—Crohn’s disease, ulcerative colitis, nutritional impairment, or serum albumin <3.0; cancer—active malignancy; and liver—any history of cirrhosis, variceal bleeding, or elevated INR in the absence of VKA therapy.
|1 Organ system|
|No more than 2 organ systems|
|≥3 Organ systems|
|None||Possible procedure-specific impediment||Possible procedure-specific impediment||Severe procedure-specific impediment|
- Nishimura R.A.
- Otto C.M.
- Bonow R.O.
- et al.
|Committee member||Employment||Consultant||Speakers bureau||Ownership/partnership/principal||Personal Research||Institutional, organizational, or other financial benefit||Expert witness||Voting recusals|
|Loren F. Hiratzka, TAD, Chair||TriHealth Heart Institute—Medical Director, Cardiac Surgery||None||None||None||None||None||None||None|
|Rick A. Nishimura, VHD, Chair||Mayo Clinic, Division of Cardiovascular Disease—Judd and Mary Morris Leighton Professor of Medicine||None||None||None||None||None||None||None|
|Mark A. Creager, TAD Liaison||Dartmouth-Hitchcock Medical Center—Director, Heart and Vascular Center and Geisel School of Medicine at Dartmouth—Professor of Medicine||None||None||None||None||None||None||None|
|Robert A. Guyton, VHD Liaison||Emory Healthcare—Professor and Chief, Division of Cardiothoracic Surgery||None||None||None||None||None||Recused|
|Eric M. Isselbacher, TAD||Massachusetts General Hospital—Co-Director Thoracic Aortic Center; Harvard Medical School—Associate Professor of Medicine||None||None||None||None||None||None||None|
|Lars G. Svensson, TAD||Cleveland Clinic, Heart and Vascular Institute—Chairman; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University—Professor of Surgery||None||None||None||None||None||Recused|
|Robert O. Bonow, VHD||Northwestern University Feinberg School of Medicine—Goldberg Distinguished Professor of Cardiology||None||None||None||None||None||None||None|
|Thoralf M. Sundt III, VHD||Massachusetts General Hospital—Chief, Division of Cardiac Surgery; Harvard Medical School—Professor of Surgery||None||None||None||None||None||Recused|
|Reviewer||Representation||Employment||Consultant||Speakers bureau||Ownership/partnership/principal||Personal research||Institutional, organizational, or other financial benefit||Expert witness|
|David H. Adams||Official reviewer—AATS||The Mount Sinai Medical Center—Marie-Josee and Henry R. Kravis Professor; Chairman, Department of Cardiothoracic Surgery||None||None||None||None||None|
|Albert T. Cheung||Official reviewer—SCA||Stanford University School of Medicine—Professor, Department of Anesthesiology; Division Chief, Cardiothoracic Anesthesiology; Program Director, Adult Cardiothoracic Anesthesiology||None||None||None||None||None|
|Michael D. Dake||Official reviewer—SIR||Stanford University School of Medicine, Cardiothoracic Surgery—Chief, Interventional Radiology||None||None||None||None||None|
|Mario J. Garcia||Official reviewer—AHA||Montefiore Medical Center-Albert Einstein College of Medicine—Chief, Division of Cardiology||None||None||None||None||None|
|Steven A. Goldstein||Official reviewer—ASE||Washington Hospital Center—Director, Noninvasive Cardiology Laboratory||None||None||None||None||None||None|
|Antionette S. Gomes||Official reviewer—AHA||UCLA School of Medicine—Professor, Radiology and Medicine||None||None||None||None||None||None|
|Anuj Gupta||Official reviewer—ACC Board of Governors||University of Maryland School of Medicine—Assistant Professor of Medicine and Director, Cardiac Catheterization Laboratory||None||None||None||None||None|
|Jonathan L. Halperin||Official reviewer—ACC/AHA Task Force on Clinical Practice Guidelines||Mt. Sinai Medical Center—Professor of Medicine||None||None||None||None||None|
|Clifford J. Kavinsky||Official reviewer—SCAI||Rush-Presbyterian-St. Luke’s Medical Center—Training Director||None||None||None||None||None||None|
|Scott Kinlay||Official reviewer—SVM||VA Boston Healthcare System—Director, Cardiac Catheterization Lab||None||None||None||None||None|
|Michael J. Mack||Official reviewer—ACC Board of Trustees||The Heart Hospital Baylor Plano—Director||None||None||None||None||None|
|Steven R. Messé||Official reviewer—ASA||University of Pennsylvania—Department of Neurology||None||None||None||None||None||None|
|Eric Roselli||Official reviewer—STS||Cleveland Clinic—Director of the Aortic Center, Heart and Vascular Institute||None||None||None||None||None|
|Frank J. Rybicki||Official reviewer—ACR||The Ottawa Hospital—Chief of Medical Imaging and Professor and Chair of Radiology||None||None||None||None||None|
|Richard D. White||Official reviewer—AHA||The Ohio State University Medical Center—Professor and Chairman, Cardiology||None||None||None||None||None||None|
Endorsed by the American College of Radiology, The American Association for Thoracic Surgery, American Society of Echocardiography, American Stroke Association, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, Society of Interventional Radiology, Society of Thoracic Surgeons, and the Society for Vascular Medicine
This document was approved by the American College of Cardiology Board of Trustees and Executive Committee, the American Heart Association Science Advisory and Coordinating Committee and the American Heart Association and Executive Committee in August 2015, and by the TAD partner organizations (AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM).
The online-only comprehensive table of author relationships with industry and other entities is available at http://jaccjacc.acc.org/Clinical_Document/TAD_VHD_Guideline_Clarification_Author_Comprehensive_RWI_Table.doc.
The American College of Cardiology Foundation requests that this document be cited as follows: Hiratzka LF, Nishimura RA, Bonow RO, Creager MA, Guyton RA, Isselbacher EM, Sundt TM 3rd, Svensson LG. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;67:724-31.
This article has been copublished in Circulation and Journal of the American College of Cardiology. Reprinted in the The Journal of Thoracic and Cardiovascular Surgery and Vascular Medicine with permission of the American College of Cardiology Foundation and the American Heart Association.
Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (my.americanheart.org). For copies of this document, please contact Elsevier Inc. Reprint Department, fax: (212) 633-3820 or E-mail: email@example.com .
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