On 29 August 2025, the updated European guidelines for the treatment of valvular heart disease were presented at the ESC Congress in Madrid. The guidelines, jointly developed by the European Society of Cardiology (ESC) and the European Society of Cardiac and Thoracic Surgery (EACTS), are based on the latest scientific evidence and are intended to support clinical practice worldwide.

The two-year collaboration between cardiologists and cardiac surgeons led to a comprehensive revision of the guidelines, which is expressly welcomed by the German Society for Thoracic, Cardiac and Vascular Surgery (DGTHG). The new recommendations aim to optimize the diagnosis and treatment of heart valve diseases and to promote decision-making in heart teams.

One of the key innovations is the enhancement of CT angiography for the exclusion diagnosis of coronary heart disease in patients with low to medium risk, which now receives an IB recommendation. In the case of tricuspid aortic valve stenosis, the age limit for catheter-based aortic valve replacement (TAVI) has been lowered from 75 to 70 years in order to enable more patients to undergo this minimally invasive procedure. For asymptomatic patients with aortic stenosis, invasive surgery – surgical or catheter-based – is now recommended as an alternative to the close monitoring that has been common up to now (IIa).

In primary mitral regurgitation, cardiac surgery remains the preferred therapy, with a new IB recommendation also for asymptomatic patients. Minimally invasive mitral valve surgery receives an IIb recommendation, while surgical intervention (IIa) or catheter-based procedure (IIb) is recommended for secondary atrial mitral valve regurgitation. In addition, the requirements for anticoagulation management after valve surgery or catheter-based procedures have been comprehensively revised in order to increase patient safety.

The guidelines underline the importance of interdisciplinary cooperation and offer clear recommendations for action to heart teams. They were presented as part of a “Hot Line” session of the ESC Congress, which underlines their high relevance for cardiology practice.

Original Paper:

2025 ESC/EACTS Guidelines for the management of valvular heart disease | European Journal of Cardio-Thoracic Surgery | Oxford Academic

Editor: X-Press Journalistenbüro GbR

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