Early intervention in asymptomatic valvular heart disease, age recommendations to decide between TAVR and surgery for aortic stenosis, and a push in favor of transcatheter repair in secondary mitral regurgitation are some of the new modifications to the European Society of Cardiology (ESC) Guidelines for the Management of Valvular Heart Disease.
This new document was presented at the ESC 2021 Congress and simultaneously published in Eur Heart J.
These guidelines emphasize the importance of working as a team with surgeons to conduct personalized patient assessment.
This is the first time that clinical practice guidelines highly recommend involving patients in the decision-making process in gray areas, and having high-volume, specialized centers take on challenging cases.
Given the vast evidence on multiple procedures published, it no longer seems appropriate for referring cardiologists to refer patients directly to a surgeon or interventional cardiologist. The appropriate course of action would be referring the patient to a center specializing in valvular heart disease where the best team decision can be made (although this is far from what happens in daily clinical practice).
In aortic stenosis, age has come to play a leading role with class I recommendations.
Read also: ESC 2021 | STEP: Blood Pressure Values in the Elderly, A Never-Ending Debate.
Surgery is recommended for patients <75 years old with low surgical risk or who are not candidates for transfemoral transcatheter aortic valve replacement (TAVR).
However, patients >75 years old or with high surgical risk (regardless of age) are candidates for TAVR.
For all other intermediate cases, both procedures are adequate, and the decision should be made according to the clinical, anatomical, and procedural characteristics discussed as a team and shared with the patient.
Read also: ESC 2021 | GREENNESS: Surprising New Protective Factor against Cardiovascular Disease.
Another important update is the recommendation to act early in aortic stenosis, aortic regurgitation, and mitral regurgitation.
Original Title: 2021 ESC/EACTS Guidelines for the management of valvular heart disease.
Reference: Alec Vahanian et al. Eur Heart J. 2021 Aug 28;ehab395. Online ahead of print. doi: 10.1093/eurheartj/ehab395.
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