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

Abstract

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Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis

“…The process for prosthesis selection for the general population is well defined in the most recent North American and European guidelines [35,36]. North American guidelines recommend the use of a mechanical valve to replace the aortic valve in patients younger than 50 years old and a mitral valve replacement for those younger than 65, unless there is a contraindication for long-life anticoagulation therapy (Class II-A), while bioprostheses are recommended for patients over 65 years old (Class II-A).…”

“…The European guidelines recommend a mechanical prosthesis in the aortic position for patients <60 years and in the mitral position for patients <65 years (Class II-A). In contrast, a bioprosthesis is recommended in situations including the following factors: patient's personal wish; poor long-term anticoagulation control; high risk of bleeding (Class I-A); low risk of future redo valve surgery; women contemplating pregnancy; age over 65 years in the aortic position; >70 years old in the mitral position; and a life expectancy lower than the predicted durability of the biological prosthesis (Class II-A) [36]. The prosthesis selection for patients with IE remains more complex than for the population without endocarditis.…”

Results after Repair of Functional Tricuspid Regurgitation with a Three-Dimensional Annuloplasty Ring

“…Hence, the previously prevailing idea that functional TR (fTR) may improve without intervention after treating the left-sided valve disease has shifted [5]. Hence, the 2021 ESC/EACTS guidelines still recommend TV repair (TVr) for patients undergoing left-sided valvular surgery in the presence of moderate/severe tricuspid insufficiency (recommendation class I, level of evidence B) or isolated annular dilation (>40 mm), even in the absence of severe TR (recommendation class IIa, level of evidence B) [6]. Moreover, surgery should be considered in patients with fTR who are symptomatic or have right ventricular dilatation, in the absence of severe right or left ventricular dysfunction and severe pulmonary vascular disease/hypertension (recommendation class IIa, level of evidence B) [6].…”

Updates on the Latest Surgical Approach of the Aortic Stenosis

“…Although initial clinical results are satisfactory, to date, we have only eight years with TAVI [2] compared to longer follow-up with surgery [3,4]. TAVI is a valuable procedure with a multitude of benefits for an increasing category of patients and now validated across all surgical profiles [5,6]. Newly emerged data from expert centers require a refocusing on the Ross procedure, the potential benefits of this procedure and its place in the surgical tool box will be discussed in this review.…”

“…In the recently published European Guidelines, non-transfemoral TAVI may be considered for inoperable or unsuitable for TF-TAVI patients, being classed as a IIb recommendation [6].…”