What is new in the 2006 ACC/AHA guidelines on valvular heart disease?

In June 2006, the American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Valvular Heart disease were published. Although many recommendations were unchanged from the 1998 guidelines, several new suggestions bear comment. The new guidelines favor a more aggressive approach to most valve lesions. For patients with low-gradient, low ejection fraction aortic stenosis, detecting inotropic reserve to help risk stratify such patients is now recommended. In the field of aortic regurgitation, the use of vasodilators to forestall surgery has been called into doubt by newer data; thus, recommendations for vasodilator use have been softened. For patients with mitral regurgitation, earlier surgery and mitral repair are highlighted. The new guidelines also reflect a growing trend toward the use of biological valves instead of mechanical prostheses. This 150-page document with more than 1000 references should be useful in guiding practice for these often complex patients. This article summarizes some of the more salient changes in 2006 compared with those of 1998.