Key take-aways
- Updated ESC/EACTS* Guidelines for Valvular Heart Disease aim to give patients access to the right treatments at the right time, including to newer, less invasive therapy options. They will help to tackle inconsistent practices that leave some patients under treated.
- The guidelines also stress that patients with complex health needs should be treated by multidisciplinary teams in high-volume specialist centers.
- The guidelines respond to an exponential increase in medical knowledge about valvular heart disease, including new data from randomised controlled trials.
Madrid, Spain – 29 August 2025: Updated ESC/EACTS Guidelines, being published today at ESC Congress 2025, aim to improve the way that patients with valvular heart disease are diagnosed and treated, responding to robust new evidence that suggests some newer and less invasive treatments could be offered more widely and consistently to patients.
The updated ESC/EACTS Guidelines have been produced by an international panel of experts that include co-Chairpersons Professor Fabien Praz, an interventional cardiologist at Bern University Hospital and Professor Michael Borger, Director of Cardiac Surgery, University of Leipzig, Germany.
The ESC/EACTS Guidelines give updated recommendations about when less invasive techniques, such as transcatheter aortic valve implantation** or minimal invasive mitral valve surgery, should be used to treat heart valve disease. The updated guidance draws on recently published research findings, including those from large randomized controlled trials.
Professor Michael Borger explained the significance of the updated guidance, "We are seeing different clinical practice to treat patients with valvular heart disease across Europe – from areas where clinical practice is way ahead of guideline recommendations, to places where patients are not getting basic treatments that they would benefit from. This means that a patient in Germany might get different treatment from someone with the same medical needs living in the UK, for example."
"Luckily there has been a rapid increase in medical knowledge, including that generated from randomized controlled trials. This has given us hugely valuable insights into how best to treat patients with different needs, and this helped our multidisciplinary team of experts to reach consensus relatively easily for many of the issues the Guidelines address. We hope that this will give clinicians across Europe and worldwide confidence that following these guidelines will help provide the best care and treatment for patients," he concluded.
Valvular heart disease is where one or more valves in the heart do not work as well as they should. Symptoms can include shortness of breath, feeling dizzy, tiredness, swollen ankles or feet and chest pain, though some patients with the disease experience no symptoms at all.
Aortic stenosis is the most commonly treated valvular heart disease in developed countries, and is estimated to affect 9 million people worldwide, while the most frequent type (treated and untreated), mitral regurgitation, is thought to affect approximately 24 million people worldwide (1). The rates of most types of valvular heart disease increase with age, affecting mainly elderly patients with other medical conditions.
The new '2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease' provide clear practical recommendations to help healthcare providers in their daily clinical decision-making. The recommendations were developed by multidisciplinary expert consensus after thorough review, analysis, and weighing of the available literature.
The updated ESC/EACTS guidelines also stress the importance of shared and patient-centred decision-making by multidisciplinary expert Heart Teams. They recommend that patients with complex conditions, or requiring complex procedures, should be referred to high-volume medical centres where they can access specialist medical knowledge.
"We know that a lot of patients with valvular heart disease aren't getting the right treatment when they need it. A major aim of this new guidance is to reduce under treatment, especially in the elderly, because this contributes to unnecessary healthcare resource use and shortened lifespan," explained Professor Fabien Praz.
"We want patients to get the best treatment for them at the right time, while also ensuring that patients with complex needs are treated in multidisciplinary teams in experienced centres with the necessary expertise. Our focus in these guidelines is the patient and their needs, including making treatment more equitable regardless of where a patient may live," Professor Praz concluded.
The new ESC/EACTS guidelines also:
- Expand guidance on sex-specific considerations for treating patients
- Stress that assessing the cause(s) and mechanism(s) of all valve diseases is central for appropriate treatment
- Outline the correct diagnostic steps and management of patients with multiple and combined valvular heart disease
- Acknowledge the increasingly important role that advanced imaging techniques, such as 3D echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) imaging, have in screening and evaluating patients with valvular heart disease
The new guidelines provide an important update on the previous 2021 ESC/EACTS Guidelines for the management of valvular heart disease (VHD).
