Updated Topics in the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Abstract

The 2025 ESC/EACTS guidelines for the management of valvular heart disease will incorporate new clinical and randomized evidence published in 2021, resulting in major updates in diagnosis and treatment. The revised guidelines reinforce multidisciplinary heart-teambased, patient-centered decision-making and recommend the referral of complex cases to experienced, high-volume centers. Advanced multimodal imaging, including three-dimensional echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is emphasized for an accurate mechanistic assessment and procedural planning. In cases of severe aortic stenosis, evidence supports earlier intervention, irrespective of symptoms or left ventricular function, with refined criteria for selecting transcatheter aortic valve implantation versus surgery based on age, anatomy, procedural risk, and lifetime management. New data have expanded the role of transcatheter aortic valve implantation in low-risk patients and selected bicuspid or aortic regurgitation cases. The updated recommendations also address mitral and tricuspid valve disease, anticoagulation, mixed valve pathology, structural valve deterioration, and sex-specific considerations, providing practical guidance for individualized care. This review article focuses on the new, revised recommendations.