Title : Guideline Directed Management of Valvular Heart Disease 2025
Abstract:
Valvular heart disease (VHD) remains a major and growing cause of cardiovascular morbidity and mortality, particularly in ageing populations. The recent ESC/EACTS 2025 Guidelines provide an updated, evidence-based framework for the diagnosis, risk stratification, and management of patients with native and prosthetic valve disease. This guideline places strong emphasis on the role of multidisciplinary Heart Teams and specialist Heart Valve Centres to ensure timely, patient-centred, and high-quality care, with appropriate selection of both surgical and transcatheter interventions.
One of the update to this guidance is in diagnostic imaging. Transthoracic and transoesophageal echocardiography remain the cornerstone of assessment, while cardiac CT and MRI, is increasingly utilised to improve diagnostic accuracy, guide procedural planning, and refine risk stratification. The guidelines also update diagnostic thresholds and expand indications for intervention, particularly in aortic stenosis and mitral regurgitation. There is a growing emphasis on earlier intervention, including in selected asymptomatic patients, where evidence suggests improved long-term outcomes compared to a watchful waiting approach.
The role of less invasive transcatheter therapies continues to expand. Procedures such as transcatheter aortic valve implantation (TAVI) and transcatheter edge-to-edge repair are increasingly recommended in appropriately selected patients, including those at intermediate or even lower surgical risk in certain clinical scenarios. This reflects accumulating evidence supporting their safety, efficacy, and durability.
In addition, the guidelines highlight the importance of individualised care and shared decision-making, taking into account patient comorbidities, frailty, and preferences. Recommendations are also provided for complex clinical situations like multivalvular disease, cancer, pregnancy, and acute heart failure. Attention is also given to optimising antithrombotic therapy and reducing under-treatment across different patient groups.
Overall, the 2025 ESC/EACTS Guidelines aim to integrate surgical and transcatheter approaches within a patient-specific, evidence-based framework to improve survival, reduce complications, and enhance quality of life in patients with valvular heart disease
