New ESC/EACTS guidelines for valvular heart disease

Updated European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines, published at ESC Congress 2025, aim to improve the way that patients with valvular heart disease are diagnosed and treated, responding to robust new evidence that suggests some newer and less invasive treatments could be offered more widely and consistently to patients. 

The new ‘2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease’ update the previous 2021 guidelines, and were produced by an international panel of experts that include co-Chairpersons Prof Fabien Praz, interventional Cardiologist, Bern University Hospital; and Prof Michael Borger, Director of Cardiac Surgery, University of Leipzig, Germany.

The guidelines give updated recommendations about when less invasive techniques, such as transcatheter aortic valve implantation or minimal invasive mitral valve surgery, should be used to treat heart valve disease. The updated guidance draws on recently published research findings from large randomised controlled trials. 

The updated ESC/EACTS guidelines also stress the importance of shared and patient-centred decision-making by multidisciplinary expert heart teams. They recommend that patients with complex conditions, or requiring complex procedures, should be referred to high-volume medical centres where they can access specialist medical knowledge.  

“We know that a lot of patients with valvular heart disease aren’t getting the right treatment when they need it. A major aim of this new guidance is to reduce under treatment, especially in the elderly, because this contributes to unnecessary healthcare resource use and shortened lifespan,” explained Prof Praz. 

The new ESC/EACTS guidelines also: 

• Expand guidance on sex-specific considerations for treating patients 

• Stress that assessing the cause(s) and mechanism(s) of all valve diseases is central for appropriate treatment 

• Outline the correct diagnostic steps and management of patients with multiple and combined valvular heart disease 

• Acknowledge the increasingly important role that advanced imaging techniques, such as 3D echocardiography, cardiac CT, and cardiac magnetic resonance imaging, have in screening and evaluating patients with valvular heart disease