The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have released the 2021 Guidelines for the Management of Valvular Heart Disease. Here are 10 essential things to remember from the new update.

Essential takeaways from the ESC/EACTS guidelines

1. A thorough assessment of the patient's history and current symptoms, as well as a thorough physical examination, are critical for diagnosing and managing valvular heart disease (VHD).
2. Echocardiography is the primary method for diagnosing and assessing VHD, as well as determining its severity and prognosis. In chosen patients, further non-invasive investigations such as cardiac magnetic resonance, cardiac computed tomography, fluoroscopy, and biomarkers offer critical supplementary information. Stress testing should be performed on a large number of asymptomatic individuals. Beyond preoperative coronary angiography, invasive examination is reserved for instances in which non-invasive assessment is equivocal.
3. Making decisions about older patients involves the integration of many factors, including an estimate of life expectancy and expected quality of life, assessment of comorbidities, and overall health (including frailty). Patient expectations and values that are informed are critical components of the decision-making process.
4. To offer high-quality treatment and appropriate training, Heart Valve Centers with interdisciplinary Heart Teams, Heart Valve Clinics, extensive equipment, and a sufficient volume of operations are needed.
5. Non-vitamin K antagonist oral anticoagulants (NOACs) are contraindicated in individuals with clinically severe mitral stenosis or mechanical valves who have atrial fibrillation. NOACs are preferred over VKAs for stroke prevention in patients with aortic stenosis, aortic and mitral regurgitation, or aortic bioprostheses >3 months after installation.
6. When the Heart Team determines the most appropriate mode of intervention for severe aortic stenosis, they should consider clinical characteristics (age and expected life expectancy, general health), anatomical characteristics, the relative risks of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), the feasibility of transfemoral TAVI, and local experience.
7. If a permanent repair of the mitral valve can be accomplished, surgical mitral valve repair is the recommended way of therapy for primary mitral regurgitation (MR). Transcatheter edge-to-edge repair (TEER) is a safe but less effective option that may be explored in individuals who have surgical contraindications or have a high risk of surgery.
8. On the other hand, in patients with severe secondary MR, medical treatment should be initiated initially, followed by cardiac resynchronization therapy if required. Mitral surgery is suggested along with coronary artery bypass grafting or other cardiac surgery in individuals who remain symptomatic. In selected individuals, isolated valve surgery may be considered. TEER should be explored in individuals who are not surgical candidates but meet criteria suggesting an improved likelihood of responding to therapy. Circulatory support devices, cardiac transplantation, or palliative care should all be explored as options for individuals with end-stage left ventricular (LV) and/or right ventricular (RV) failure.
9. At the time of left-sided valve surgery, tricuspid regurgitation should be aggressively addressed. Isolated tricuspid regurgitation surgery (with or without prior left-sided valve surgery) necessitates a thorough evaluation of the underlying illness, pulmonary hemodynamics, and RV function.
10. The decision between a mechanical and a bioprosthesis should be patient-centred and multifactorial, taking into account patient characteristics, the reason for lifelong anticoagulation, the possibility and dangers of re-intervention, and the informed patient preference. Clinical evaluations of prosthetic valves should be done on an annual basis and as soon as new heart symptoms manifest.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.