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

Abstract

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC 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 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 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 the patient's caregiver where appropriate and/or necessary. Nor do the ESC Guidelines exempt health professionals from taking careful and full consideration of 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 scientifically 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.

Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Moderate Aortic Regurgitation: Potential Implications for Treatment Decision-Making

“…In this scenario, AVI serves mainly as prophylaxis in the treatment of moderate AR to avoid repeat open-heart surgery. This indication remains controversial in 2021 ESC/EACTS guidelines, as previous small single-center data showed that the progression of moderate AR is slow and indolent ( 6 , 23 ). However, a recent large-sample investigation of the natural history of AR showed that the 10-year incidence of progression to stage C/D AR was 53.4% among patients with moderate AR (median 2.96 [1.2–5.4] years), in contrast to those with trivial/mild AR (11.7%, HR = 4.71) ( 24 ).…”

“…As a common indicator of LVSD, reduced LV ejection fraction (LVEF) <50 or 55% is known to be a potent predictor of poor prognosis and serves as a reasonable indication for aortic valve intervention (AVI) in patients with severe AR ( 6 , 7 ). However, the prognostic value of LVEF and its best cutoff for risk prediction in patients with moderate AR remain unclear.…”

Valve-in-valve transcatheter aortic valve replacement: the challenge of the next future

“…There are two main groups of bioprosthetic surgical valves: stented and stentless surgical devices [13,14] . Stentless valves, representing approximately 20% of patients with ViV, most frequently present with regurgitation as a modality of degeneration, with lower postprocedural gradients than those observed with stented valves but with higher rates of periprocedural complications as initial device malposition, second transcatheter device, coronary obstruction and paravalvular leak, but no difference in 30-day and 1-year outcome [7] . Stented valves, especially those with externally mounted leaflets (e.g., Mitroflow, Livanova PLC/Sorin Group, Saluggia, Italy), have frequently been used in the past, mainly in small anatomies, because they guarantee a lower final gradient, but these are the valves at the highest risk for coronary obstruction in ViV procedures [15,16] .…”

“…Among the hypotheses evaluated, it appears that this complication may result from design factors [87] . Therefore, a more aggressive anticoagulation regimen after ViV TAVR is recommended, especially in patient with high thrombotic risk and low hemorrhagic risk [7] .…”

“…ViV TAVR is more complex than native valve TAVR and should ideally be performed by experienced teams after a multidisciplinary decision in the heart team according to the latest guidelines [7,8] . Therefore, a standardized approach and a meticulous pre-procedural planning are the keys to success.…”