Summary

Summary ESC/EACTS Guidelines for the management of valvular heart disease

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Table of Contents 1 Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.1Why do we need new guidelines on valvular heart disease? . . . . . 6 2.2Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.3Content of these guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.4Newformat of the guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5Howto use these guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3General comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.1Concepts ofHeart TeamandHeartValveCentre . . . . . . . . . . . . . 13 3.2 Patient evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.2.1Clinical evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.2.2 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.2.3 Other non-invasive investigations . . . . . . . . . . . . . . . . . . . . . . . . 15 3.2.4 Invasive investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3.2.5Assessmentof comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3.3 Risk stratification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3.3.1 Risk scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.3.2Other factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.4 Patient-related aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.5 Local resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.6Management of associated conditions . . . . . . . . . . . . . . . . . . . . . . . . 16 3.6.1Coronary artery disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.6.2Atrial fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3.7 Endocarditis prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3.8 Prophylaxis for rheumatic fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4Aortic regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.1.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.1.2 Computed tomography and cardiac magnetic resonance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 4.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 4.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5Aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.1.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.1.2 Additional diagnostic and prognostic parameters . . . . . . . . . 21 5.1.3 TAVI diagnostic workup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 5.2 Indications for intervention (SAVR orTAVI) . . . . . . . . . . . . . . . . . . 24 5.2.1 Symptomatic aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 5.2.2Asymptomatic aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5.2.3 Themode of intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 5.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 5.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 6Mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 6.1 Primarymitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 6.1.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 6.1.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 6.1.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 6.1.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 562 ESC/EACTS Guidelines Online publish-ahead-of-print 28 August 2021 Downloaded from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1.5 Special populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 6.2 Secondarymitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 6.2.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 6.2.2Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 6.2.3 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 7Mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 7.1 Rheumaticmitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 7.1.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 7.1.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 7.1.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 7.1.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 7.1.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 7.2 Degenerative mitral stenosis with mitral annular calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 7.2.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 7.2.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 8 Tricuspid regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 8.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 8.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 8.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 9 Tricuspid stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 9.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 9.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 9.3Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 10Combined andmultiple-valve diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 11 Prosthetic valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 11.1Choice of prosthetic valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 11.2 Baseline assessment and follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . 41 11.3Antithromboticmanagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 11.3.1Mechanical prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 11.3.2 Bioprostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 11.3.3Valve repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 11.4Management of prosthetic valve dysfunction and complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 11.4.1 Structural valve deterioration . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 11.4.2 Non-structural valve dysfunction . . . . . . . . . . . . . . . . . . . . . . . 46 11.4.3 Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 11.4.4Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 11.4.5Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 12Management during non-cardiac surgery . . . . . . . . . . . . . . . . . . . . . . . . 47 12.1 Preoperative evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 12.2 Specific valve lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 12.2.1Aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 12.2.2Mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 12.2.3Aortic andmitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . 47 12.3 Perioperativemonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 13Management during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 13.1Management before pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 13.2Management during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 13.2.1 Patientswith native valve disease . . . . . . . . . . . . . . . . . . . . . . . 48 13.2.2Mechanical prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 14Keymessages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 15Gaps in evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 16ToDo andNot ToDo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 17 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 18Author information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 19Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 20References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 List of Tables Table 1Classes of recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 3What is new . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table 4 Requirements for aHeartValveCentre . . . . . . . . . . . . . . . . . . . . 13 Table 5 Echocardiographic criteria for the definition of severe aortic valve regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 6 Clinical, anatomical and procedural factors that influence the choice of treatment modality for an individual patient . . . . . . . . . . . . 23 Table 7 Severe mitral regurgitation criteria based on 2D echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 8 Contraindications for percutaneous mitral commissurotomy in rheumaticmitral stenosisa . . . . . . . . . . . . . . . . . . . . . 34 Table 9 Echocardiographic criteria for grading severity of tricuspid regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 10 Target international normalized ratio for mechanical prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 List of Figures Figure 1 Central illustration: Patient-centred evaluation for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 2 Management of patients with aortic regurgitation . . . . . . . . . . . 20 Figure 3 Integrated imaging assessment of aortic stenosis . . . . . . . . . . . . 22 Figure 4 Management of patients with severe aortic stenosis . . . . . . . . . 24 Figure 5 Management of patients with severe chronic primary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Figure 6 Management of patients with chronic severe secondary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Figure 7 Management of clinically significant rheumatic mitral stenosis (MVA <_1.5 cm2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Figure 8 Management of tricuspid regurgitation (TR) . . . . . . . . . . . . . . . . 38 Figure 9 Antithrombotic therapy for valve prostheses . . . . . . . . . . . . . . . 44 Figure 10Management of left-sided obstructive and non-obstructive mechanical prosthetic thrombosis . . . . . . . . . . . . . . . . . 45 Figure 11Management of non-cardiac surgery (NCS) in patientswith severe aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Tables of Recommendations Recommendations for management of CAD in patients withVHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Recommendations on management of atrial fibrillation in patientswith native VHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Recommendations on indications for surgery in (A) severe aortic regurgitation and (B) aortic root or tubular ascending aortic aneurysm (irrespective of the severity of aortic regurgitation) . . . . . . . 19 Recommendations on indications for interventiona in symptomatic (A) and asymptomatic (B) aortic stenosis and recommended mode of intervention (C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Recommendations on indications for intervention in severe primarymitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 ESC/EACTS Guidelines 563 Downloaded from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommendations on indications for mitral valve intervention in chronic severe secondarymitral regurgitation . . . . . . . . . . . . . . . . . . . . . . 32 Recommendations on indications for percutaneous mitral commissurotomy andmitral valve surgery in clinically significant (moderate or severe) mitral stenosis (valve area <_1.5 cm2) . . . . . . . . . . 34 Recommendations on indications for intervention in tricuspid valve disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Recommendations for prosthetic valve selection . . . . . . . . . . . . . . . . . . . . 40 Recommendations for management of antithrombotic therapy after prosthetic valve implantation or valve repair in the perioperative and postoperative periods . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Recommendations onmanagement of prosthetic valve dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Abbreviations and acronyms 2D Two-dimensional 3D Three-dimensional ACEI Angiotensin-converting enzyme inhibitor ACS Acute coronary syndrome AF Atrial fibrillation ARB Angiotensin receptor blocker ARC-HBR Academic Research Consortium High Bleeding Risk ASA Acetylsalicylic acid AVA Aortic valve area BAV Balloon aortic valvuloplasty BHV Biological heart valve BVF Bioprosthetic valve failure BNP B-type natriuretic peptide BP Blood pressure BSA Body surface area CABG Coronary artery bypass grafting CAD Coronary artery disease CCT Cardiac computed tomography CI Confidence interval CMR Cardiac magnetic resonance CRT Cardiac resynchronization therapy CT Computed tomography DAPT Dual antiplatelet therapy DPm Mean pressure gradient DSE Dobutamine stress echocardiography DVI Doppler velocity index/dimensionless index EACTS European Association for Cardio-Thoracic Surgery ECG Electrocardiogram EDV End-diastolic velocity EROA Effective regurgitant orifice area ESC European Society of Cardiology EuroSCORE European System for Cardiac Operative Risk Evaluation FFP Fresh frozen plasma GDMT Guideline-directed medical treatment therapy HALT Hypo-attenuated leaflet thickening HTx Heart transplantation INR International normalized ratio i.v. Intravenous LA Left atrium/left atrial LAA Left atrial appendage LMWH Low-molecular-weight heparin LV Left ventricle/left ventricular LVAD Left ventricular assist devices LVEDD Left ventricular end-diastolic diameter LVEF Left ventricular ejection fraction LVESD Left ventricular end-systolic diameter LVOT Left ventricular outflow tract MAC Mitral annular calcification MHV Mechanical heart valve MIDA Mitral Regurgitation International Database MVA Mitral valve area NCS Non-cardiac surgery NOAC Non-vitamin K antagonist oral anticoagulant NYHA New York Heart Association OAC Oral anticoagulation PCC Prothrombin complex concentration PCI Percutaneous coronary intervention PET Positron emission tomography PISA Proximal isovelocity surface area PMC Percutaneous mitral commissurotomy PMR Primary mitral regurgitation PPM Patient-prosthesis mismatch PROM Predicted risk of mortality RCT Randomized controlled trial RV Right ventricle/right ventricular SAPT Single antiplatelet therapy SAVR Surgical aortic valve replacement SMR Secondary mitral regurgitation SVD Structural valve deterioration SPAP Systolic pulmonary arterial pressure STS Society of Thoracic Surgeons SVi Stroke volume index TAPSE Tricuspid annular pulmonary systolic excursion TAVI Transcatheter aortic valve implantation TE Thromboembolism TEER Transcatheter edge-to-edge repair TTVI Transcatheter tricuspid valve intervention TOE Transoesophageal echocardiography TTE Transthoracic echocardiography TVI Time-velocity integral TVR Tricuspid valve replacement or repair UFH Unfractionated heparin VHD Valvular heart disease VKA Vitamin K antagonist Vmax Peak transvalvular velocity

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Uploaded on: October 11, 2024
Number of pages: 72
Written in: 2024/2025
Type: Summary

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esc management of valvular heart disease
developed by the task force for the management of
esceacts guidelines for the management of valvula

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ESC/EACTS GUIDELINES
European Heart Journal (2022) 43, 561–632
https://doi.org/10.1093/eurheartj/ehab395

2021 ESC/EACTS Guidelines for the
management of valvular heart disease

Downloaded from https://academic.oup.com/eurheartj/article/43/7/561/6358470 by University of Bahrain user on 16 October 2023
Developed by the Task Force for the management of valvular heart
disease of the European Society of Cardiology (ESC) and the
European Association for Cardio-Thoracic Surgery (EACTS)
Authors/Task Force Members: Alec Vahanian * (ESC Chairperson) (France),
Friedhelm Beyersdorf*1 (EACTS Chairperson) (Germany), Fabien Praz
(ESC Task Force Coordinator) (Switzerland), Milan Milojevic1 (EACTS Task Force
Coordinator) (Serbia), Stephan Baldus (Germany), Johann Bauersachs (Germany),
Davide Capodanno (Italy), Lenard Conradi1 (Germany), Michele De Bonis1 (Italy),
Ruggero De Paulis1 (Italy), Victoria Delgado (Netherlands), Nick Freemantle1
(United Kingdom), Martine Gilard (France), Kristina H. Haugaa (Norway),
Anders Jeppsson1 (Sweden), Peter Jüni (Canada), Luc Pierard (Belgium),
Bernard D. Prendergast (United Kingdom), J. Rafael Sadaba1 (Spain),
Christophe Tribouilloy (France), Wojtek Wojakowski (Poland), ESC/EACTS
Scientific Document Group
* Corresponding authors: Alec Vahanian, UFR Medecine, Université de Paris, site Bichat, 16 rue Huchard, 75018 Paris, France; and LVTS INSERM U1148, GH Bichat, 46, rue
Henri Huchard, 75018 Paris, France. Tel: þ 33 6 63 15 56 68, E-mail: ; Friedhelm Beyersdorf, Department of Cardiovascular Surgery, University Heart
Center, University Hospital Freiburg, Germany; and Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany, Hugstetterstr. 55, D-79106 Freiburg, Germany. Tel:
þ49 761 270 28180. E-mail:
Author/Task Force Member affiliations: listed in Author information.
ESC Clinical Practice Guidelines Committee (CPG): listed in the Appendix.
EACTS Council: listed in the Appendix.
1
Representing the European Association for Cardio-Thoracic Surgery (EACTS)
ESC subspecialty communities having participated in the development of this document:
Associations: Association for Acute CardioVascular Care (ACVC), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous
Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA).
Councils: Council on Valvular Heart Disease.
Working Groups: Cardiovascular Surgery, Thrombosis.
Patient Forum
The content of these European Society of Cardiology (ESC) / European Association for Cardio-Thoracic Surgery (EACTS) Guidelines has been published for personal and educa-
tional use only. No commercial use is authorized. No part of the ESC/EACTS Guidelines may be translated or reproduced in any form without written permission from the ESC
and the EACTS. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party author-
ized to handle such permissions on behalf of the ESC ().
Disclaimer: The ESC/EACTS Guidelines represent the views of the ESC and the EACTS and were produced after careful consideration of the scientific and medical knowledge
and the evidence available at the time of their publication. The ESC and the EACTS are not responsible in the event of any contradiction, discrepancy and/or ambiguity between
the ESC/EACTS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health-
care or therapeutic strategies. Health professionals are encouraged to take the ESC/EACTS Guidelines fully into account when exercising their clinical judgment, as well as in the
determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC/EACTS Guidelines do not override, in any way whatsoever,
the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that
patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC/EACTS Guidelines exempt health professionals from taking into full and careful consid-
eration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scien-
tifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and
regulations relating to drugs and medical devices at the time of prescription.
C the European Society of Cardiology and the
This article has been co-published with permission in the European Heart Journal and European Journal of Cardio-Thoracic Surgery. V
European Association for Cardio-Thoracic Surgery 2021. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each jour-
nal’s style. Either citation can be used when citing this article. For permissions, please email .

,562 ESC/EACTS Guidelines

Document Reviewers: Franz-Josef Neumann (ESC Review Coordinator) (Germany), Patrick Myers1
(EACTS Review Coordinator) (Switzerland), Magdy Abdelhamid (Egypt), Stephan Achenbach (Germany),
Riccardo Asteggiano (Italy), Fabio Barili1 (Italy), Michael A. Borger (Germany), Thierry Carrel1
(Switzerland), Jean-Philippe Collet (France), Dan Foldager (Denmark), Gilbert Habib (France),
Christian Hassager (Denmark), Alar Irs1 (Estonia), Bernard Iung (France), Marjan Jahangiri1 (United
Kingdom), Hugo A. Katus (Germany), Konstantinos C. Koskinas (Switzerland), Steffen Massberg
(Germany), Christian E. Mueller (Switzerland), Jens Cosedis Nielsen (Denmark), Philippe Pibarot (Canada),
Amina Rakisheva (Kazakhstan), Marco Rofﬁ (Switzerland), Andrea Rubboli (Italy), Evgeny Shlyakhto
(Russia), Matthias Siepe1 (Germany), Marta Sitges (Spain), Lars Sondergaard (Denmark),
Miguel Sousa-Uva1 (Portugal), Guiseppe Tarantini (Italy), Jose Luis Zamorano (Spain)

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All experts involved in the development of these guidelines have submitted declarations of interest.
These have been compiled in a report and published in a supplementary document simultaneously to the
guidelines. The report is also available on the ESC website www.escardio.org/guidelines.

For the Supplementary Data which include background information and detailed discussion of the data
that have provided the basis for the guidelines see European Heart Journal online.
Online publish-ahead-of-print 28 August 2021

...................................................................................................................................................................................................
Keywords Guidelines • valvular heart disease • valve disease • valve surgery • percutaneous valve intervention •
aortic regurgitation • aortic stenosis • mitral regurgitation • mitral stenosis • tricuspid regurgitation •
tricuspid stenosis • prosthetic heart valves

..
Table of Contents ..
..
4 Aortic regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
.. 4.1.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1 Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
..
.. 4.1.2 Computed tomography and cardiac magnetic
2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 .. resonance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.1 Why do we need new guidelines on valvular heart disease? . . . . . 6
..
.. 4.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.2 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ..
2.3 Content of these guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
.. 4.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
.. 4.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.4 New format of the guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 ..
2.5 How to use these guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
.. 4.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
.. 5 Aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3 General comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ..
.. 5.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.1 Concepts of Heart Team and Heart Valve Centre . . . . . . . . . . . . . 13 .. 5.1.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2 Patient evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ..
.. 5.1.2 Additional diagnostic and prognostic parameters . . . . . . . . . 21
3.2.1 Clinical evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 .. 5.1.3 TAVI diagnostic workup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.2.2 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 ..
.. 5.2 Indications for intervention (SAVR or TAVI) . . . . . . . . . . . . . . . . . . 24
3.2.3 Other non-invasive investigations . . . . . . . . . . . . . . . . . . . . . . . . 15 .. 5.2.1 Symptomatic aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.2.4 Invasive investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 ..
.. 5.2.2 Asymptomatic aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.2.5 Assessment of comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 .. 5.2.3 The mode of intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.3 Risk stratification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 ..
.. 5.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.3.1 Risk scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 .. 5.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.3.2 Other factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ..
.. 5.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.4 Patient-related aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 .. 6 Mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.5 Local resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ..
.. 6.1 Primary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.6 Management of associated conditions . . . . . . . . . . . . . . . . . . . . . . . . 16 .. 6.1.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.6.1 Coronary artery disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ..
.. 6.1.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.6.2 Atrial fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 .. 6.1.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.7 Endocarditis prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
..
.. 6.1.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.8 Prophylaxis for rheumatic fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 ..

,ESC/EACTS Guidelines 563

.. 20 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.1.5 Special populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 ..
6.2 Secondary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 ..
..
6.2.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 .. List of Tables
6.2.2 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 ..
..
6.2.3 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 .. Table 1 Classes of recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
7 Mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 .. Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
..
7.1 Rheumatic mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 .. Table 3 What is new . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
7.1.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 .. Table 4 Requirements for a Heart Valve Centre . . . . . . . . . . . . . . . . . . . . 13
..
7.1.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 .. Table 5 Echocardiographic criteria for the definition of severe
7.1.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 .. aortic valve regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

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..
7.1.4 Serial testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 .. Table 6 Clinical, anatomical and procedural factors that influence
7.1.5 Special patient populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ..
.. the choice of treatment modality for an individual patient . . . . . . . . . . . . 23
7.2 Degenerative mitral stenosis with mitral annular .. Table 7 Severe mitral regurgitation criteria based on 2D
calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ..
.. echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
7.2.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 .. Table 8 Contraindications for percutaneous mitral
7.2.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
..
.. commissurotomy in rheumatic mitral stenosisa . . . . . . . . . . . . . . . . . . . . . 34
8 Tricuspid regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 .. Table 9 Echocardiographic criteria for grading severity of tricuspid
8.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
..
.. regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
8.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 .. Table 10 Target international normalized ratio for mechanical
8.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
..
.. prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
9 Tricuspid stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 ..
9.1 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
..
..
9.2 Indications for intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 .. List of Figures
..
9.3 Medical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 .. Figure 1 Central illustration: Patient-centred evaluation for
10 Combined and multiple-valve diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 ..
.. intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
11 Prosthetic valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 .. Figure 2 Management of patients with aortic regurgitation . . . . . . . . . . . 20
11.1 Choice of prosthetic valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 ..
.. Figure 3 Integrated imaging assessment of aortic stenosis . . . . . . . . . . . . 22
11.2 Baseline assessment and follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . 41 .. Figure 4 Management of patients with severe aortic stenosis . . . . . . . . . 24
11.3 Antithrombotic management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 ..
.. Figure 5 Management of patients with severe chronic primary
11.3.1 Mechanical prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 .. mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
11.3.2 Bioprostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 ..
.. Figure 6 Management of patients with chronic severe secondary
11.3.3 Valve repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 .. mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
11.4 Management of prosthetic valve dysfunction and ..
.. Figure 7 Management of clinically significant rheumatic mitral
complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 .. stenosis (MVA <_1.5 cm2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
11.4.1 Structural valve deterioration . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 ..
.. Figure 8 Management of tricuspid regurgitation (TR) . . . . . . . . . . . . . . . . 38
11.4.2 Non-structural valve dysfunction . . . . . . . . . . . . . . . . . . . . . . . 46 .. Figure 9 Antithrombotic therapy for valve prostheses . . . . . . . . . . . . . . . 44
11.4.3 Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
..
.. Figure 10 Management of left-sided obstructive and
11.4.4 Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 .. non-obstructive mechanical prosthetic thrombosis . . . . . . . . . . . . . . . . . 45
11.4.5 Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
..
.. Figure 11 Management of non-cardiac surgery (NCS) in
12 Management during non-cardiac surgery . . . . . . . . . . . . . . . . . . . . . . . . 47 .. patients with severe aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
12.1 Preoperative evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
..
..
12.2 Specific valve lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 ..
12.2.1 Aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
..
..
12.2.2 Mitral stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 .. Tables of Recommendations
12.2.3 Aortic andmitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . 47
..
..
12.3 Perioperativemonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 .. Recommendations for management of CAD in patients
..
13 Management during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 .. with VHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
13.1 Management before pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 .. Recommendations on management of atrial fibrillation in
..
13.2 Management during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 .. patients with native VHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
13.2.1 Patients with native valve disease . . . . . . . . . . . . . . . . . . . . . . . 48 .. Recommendations on indications for surgery in (A) severe aortic
..
13.2.2 Mechanical prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 .. regurgitation and (B) aortic root or tubular ascending aortic
14 Key messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 .. aneurysm (irrespective of the severity of aortic regurgitation) . . . . . . . 19
..
15 Gaps in evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 .. Recommendations on indications for interventiona in symptomatic
16 To Do and Not To Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 .. (A) and asymptomatic (B) aortic stenosis and recommended
..
17 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 .. mode of intervention (C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
18 Author information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 .. Recommendations on indications for intervention in severe
..
19 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 . primary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

, 564 ESC/EACTS Guidelines

Recommendations on indications for mitral valve intervention in .. LA Left atrium/left atrial
..
chronic severe secondary mitral regurgitation . . . . . . . . . . . . . . . . . . . . . . 32 .. LAA Left atrial appendage
Recommendations on indications for percutaneous mitral .. LMWH Low-molecular-weight heparin
..
commissurotomy and mitral valve surgery in clinically significant .. LV Left ventricle/left ventricular
(moderate or severe) mitral stenosis (valve area <_1.5 cm2) . . . . . . . . . . 34 .. LVAD Left ventricular assist devices
..
Recommendations on indications for intervention in tricuspid .. LVEDD Left ventricular end-diastolic diameter
valve disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 .. LVEF Left ventricular ejection fraction
..
Recommendations for prosthetic valve selection . . . . . . . . . . . . . . . . . . . . 40 .. LVESD Left ventricular end-systolic diameter
Recommendations for management of antithrombotic therapy ..
.. LVOT Left ventricular outflow tract
after prosthetic valve implantation or valve repair in the ..

Downloaded from https://academic.oup.com/eurheartj/article/43/7/561/6358470 by University of Bahrain user on 16 October 2023
MAC Mitral annular calcification
perioperative and postoperative periods . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 ..
.. MHV Mechanical heart valve
Recommendations on management of prosthetic valve .. MIDA Mitral Regurgitation International Database
dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 ..
.. MVA Mitral valve area
.. NCS Non-cardiac surgery
..
.. NOAC Non-vitamin K antagonist oral anticoagulant
Abbreviations and acronyms .. NYHA New York Heart Association
..
.. OAC Oral anticoagulation
2D Two-dimensional .. PCC Prothrombin complex concentration
3D Three-dimensional ..
.. PCI Percutaneous coronary intervention
ACEI Angiotensin-converting enzyme inhibitor .. PET Positron emission tomography
ACS Acute coronary syndrome ..
.. PISA Proximal isovelocity surface area
AF Atrial fibrillation .. PMC Percutaneous mitral commissurotomy
ARB Angiotensin receptor blocker ... PMR Primary mitral regurgitation
ARC-HBR Academic Research Consortium High Bleeding ..
.. PPM Patient-prosthesis mismatch
Risk .. PROM Predicted risk of mortality
ASA Acetylsalicylic acid ..
.. RCT Randomized controlled trial
AVA Aortic valve area .. RV Right ventricle/right ventricular
BAV Balloon aortic valvuloplasty
..
.. SAPT Single antiplatelet therapy
BHV Biological heart valve .. SAVR Surgical aortic valve replacement
BVF Bioprosthetic valve failure
..
.. SMR Secondary mitral regurgitation
BNP B-type natriuretic peptide ..
.. SVD Structural valve deterioration
BP Blood pressure .. SPAP Systolic pulmonary arterial pressure
BSA Body surface area ..
CABG Coronary artery bypass grafting
.. STS Society of Thoracic Surgeons
.. SVi Stroke volume index
CAD Coronary artery disease ..
.. TAPSE Tricuspid annular pulmonary systolic excursion
CCT Cardiac computed tomography .. TAVI Transcatheter aortic valve implantation
CI Confidence interval ..
.. TE Thromboembolism
CMR Cardiac magnetic resonance .. TEER Transcatheter edge-to-edge repair
CRT Cardiac resynchronization therapy ..
.. TTVI Transcatheter tricuspid valve intervention
CT Computed tomography .. TOE Transoesophageal echocardiography
DAPT Dual antiplatelet therapy ..
.. TTE Transthoracic echocardiography
DPm Mean pressure gradient .. TVI Time-velocity integral
DSE Dobutamine stress echocardiography ..
.. TVR Tricuspid valve replacement or repair
DVI Doppler velocity index/dimensionless index .. UFH Unfractionated heparin
EACTS European Association for Cardio-Thoracic Surgery ..
.. VHD Valvular heart disease
ECG Electrocardiogram .. VKA Vitamin K antagonist
EDV End-diastolic velocity ..
.. Vmax Peak transvalvular velocity
EROA Effective regurgitant orifice area ..
ESC European Society of Cardiology ..
..
EuroSCORE European System for Cardiac Operative Risk ..
Evaluation
.. 1 Preamble
..
FFP Fresh frozen plasma .. Guidelines summarize and evaluate available evidence with the aim of
GDMT Guideline-directed medical treatment therapy
..
.. assisting health professionals in proposing the best management
HALT Hypo-attenuated leaflet thickening .. strategies for an individual patient with a given condition. Guidelines
HTx Heart transplantation
..
.. and their recommendations should facilitate decision making of
INR International normalized ratio .. health professionals in their daily practice. However, the final deci-
i.v. Intravenous
..
. sions concerning an individual patient must be made by the

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Summary ESC/EACTS Guidelines for the management of valvular heart disease

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