ESC 2021 2021 ESC/EACTS Guidelines for the management of valvular heart disease
European Society of Cardiology｜循環器 / 弁膜疾患｜72 ページ｜チャンク 751｜推奨 142 件｜superseded
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.16 | I | C | Diagnosis of CAD Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following: • History of cardiovascular disease. • Suspected myocardial ischaemia.c • LV systolic dysfunction. • In men >40 years of age and postmenopausal women. • One or more cardiovascular risk factors. | |
| p.17 | I | C | Coronary angiography is recommended in the evaluation of severe SMR. | |
| p.17 | IIa | C | Coronary CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD.d | |
| p.17 | I | C | Indications for myocardial revascularization CABG is recommended in patients with a primary indication for aortic/mitral/tricuspid valve surgery and coronary artery diameter stenosis >_70%.e,f | |
| p.17 | IIa | C | CABG should be considered in patients with a primary indication for aortic/mitral/tricuspid valve surgery and coronary artery diameter stenosis >_5070%. | |
| p.17 | IIa | C | PCI should be considered in patients with a pri- mary indication to undergo TAVI and coronary artery diameter stenosis >70% in proximal segments. | |
| p.17 | I | A | Anticoagulation ESC/EACTS 2021 For stroke prevention in AF patients who are eligible for OAC, NOACs are recommended in preference to VKAs in patients with aortic stenosis, aortic and mitral regurgitation.7578,83,84 | |
| p.17 | III | C | The use of NOACs is not recommended in patients with AF and moderate to severe mitral stenosis. Surgical interventions | |
| p.17 | IIa | A | Concomitant AF ablation should be considered in patients undergoing valve surgery, balancing the benefits of freedom from atrial arrhythmias and the risk factors for recurrence (LA dilata- tion, years in AF, age, renal dysfunction, and other cardiovascular risk factors).79,8590 | |
| p.17 | IIa | B | ................................................................................................................................... LAA occlusion should be considered to reduce the thromboembolic risk in patients, with AF and a CHA2DS2VASc score >_2 undergoing valve surgery.82 | |
| p.19 | I | B | patients regardless of LV function.105109 | |
| p.19 | I | B | A) Severe aortic regurgitation Surgery is recommended in symptomatic Surgery is recommended in asymptomatic patients with LVESD >50 mm or LVESD >25 mm/m2 BSA (in patients with small body size) or resting LVEF <_50%.107,108,112,114,115 | |
| p.19 | IIb | C | Surgery may be considered in asymptomatic patients with LVESD >20 mm/m2 BSA (especially in patients with small body size) or resting LVEF <_55%, if surgery is at low risk. | |
| p.19 | I | C | Surgery is recommended in symptomatic and asymptomatic patients with severe aortic regur- gitation undergoing CABG or surgery of the ascending aorta or of another valve. | |
| p.19 | IIb | C | Aortic valve repair may be considered in selected patients at experienced centres when durable results are expected. | |
| p.19 | I | B | Valve-sparing aortic root replacement is recom- mended in young patients with aortic root dilation, if performed in experienced centres and durable results are expected.133136,140 | |
| p.19 | I | C | Ascending aortic surgery is recommended in patients with Marfan syndrome who have aortic root disease with a maximal ascending aortic diameter >_50 mm. | |
| p.20 | IIa | C | Ascending aortic surgery should be considered in patients who have aortic root disease with maximal ascending aortic diameter: • >_55 mm in all patients. • >_45 mm in the presence of Marfan syndrome and additional risk factorsd or patients with a TGFBR1 or TGFBR2 mutation (including LoeysDietz syndrome).e | |
| p.20 | IIa | C | • >_50 mm in the presence of a bicuspid valve with additional risk factorsd or coarctation. When surgery is primarily indicated for the aortic valve, replacement of the aortic root or tubular ascending aorta should be considered when >_45 mm.f | |
| p.26 | I | B | Intervention is recommended in symptomatic patients with severe, high-gradient aortic steno- sis [mean gradient >_40 mmHg, peak velocity >_4.0 m/s, and valve area <_1.0 cm2 (or <_0.6 cm2/ m2)].235,236 | |
| p.26 | IIa | C | Intervention should be considered in symptomatic patients with low-flow, low-gradient (<40 mmHg) aortic stenosis with normal ejec- tion fraction after careful confirmation that the aortic stenosis is severed (Figure 3). | |
| p.26 | IIa | C | Intervention should be considered in sympto- matic patients with low-flow, low-gradient severe aortic stenosis and reduced ejection fraction without flow (contractile) reserve, particu- larly when CCT calcium scoring confirms severe aortic stenosis. | |
| p.26 | III | C | Intervention is not recommended in patients with severe comorbidities when the intervention is unlikely to improve quality of life or prolong survival >1 year. | |
| p.26 | I | B | Intervention is recommended in asymptomatic patients with severe aortic stenosis and systolic LV dysfunction (LVEF <50%) without another cause.9,238,239 | |
| p.26 | I | C | Intervention is recommended in asymptomatic patients with severe aortic stenosis and demonstrable symptoms on exercise testing. | |
| p.26 | IIa | B | Intervention should be considered in asympto- matic patients with severe aortic stenosis and systolic LV dysfunction (LVEF <55%) without another cause.9,240,241 | |
| p.26 | IIa | C | Intervention should be considered in asympto- matic patients with severe aortic stenosis and a sustained fall in BP (>20 mmHg) during exercise testing. | |
| p.26 | IIa | B | matic patients with LVEF >55% and a normal exercise test if the procedural risk is low and one of the following parameters is present: • Very severe aortic stenosis (mean gradient >_60 mmHg or Vmax >5 m/s).9,242 • Severe valve calcification (ideally assessed by CCT) and Vmax progression >_0.3 m/s/ year.164,189,243 • Markedly elevated BNP levels (>3 age- and sex-corrected normal range) confirmed by | |
| p.26 | I | C | repeated measurements and without other explanation.163,171 C) Mode of intervention Aortic valve interventions must be performed in Heart Valve Centres that declare their local expertise and outcomes data, have active inter- ventional cardiology and cardiac surgical pro- grammes on site, and a structured collaborative Heart Team approach. | |
| p.26 | I | C | The choice between surgical and transcatheter intervention must be based upon careful evaluation of clinical, anatomical, and procedural fac- tors by the Heart Team, weighing the risks and benefits of each approach for an individual patient. The Heart Team recommendation should be discussed with the patient who can | |
| p.26 | I | B | Continued ............................................................................................................................................................................ Intervention should be considered in asympto- then make an informed treatment choice. SAVR is recommended in younger patients who are low risk for surgery (<75 yearse and STS- PROM/EuroSCORE II <4%)e,f, or in patients who are operable and unsuitable for transfemoral TAVI.244 | |
| p.26 | I | A | TAVI is recommended in older patients (>_75 years), or in those who are high risk (STS- PROM/EuroSCORE IIf >8%) or unsuitable for surgery.197206,245 | |
| p.26 | I | B | SAVR or TAVI are recommended for remaining patients according to individual clinical, anatomical, and procedural character- istics.202205,207,209,210,212 f,g | |
| p.26 | IIb | C | Non-transfemoral TAVI may be considered in patients who are inoperable and unsuitable for transfemoral TAVI. | |
| p.26 | IIb | C | Balloon aortic valvotomy may be considered as a bridge to SAVR or TAVI in haemodynamically unstable patients and (if feasible) in those with severe aortic stenosis who require urgent high- risk NCS (Figure 11). | |
| p.26 | I | C | diac/ascending aorta surgery SAVR is recommended in patients with severe aortic stenosis undergoing CABG or surgical intervention on the ascending aorta or another valve. | |
| p.27 | IIa | C | SAVR should be considered in patients with moderate aortic stenosish undergoing CABG or surgical intervention on the ascending aorta or another valve after Heart Team discussion. | |
| p.29 | I | B | Mitral valve repair is the recommended surgical technique when the results are expected to be durable.293296 | |
| p.29 | I | B | Surgery is recommended in symptomatic patients who are operable and not high risk.293296 | |
| p.29 | I | B | Surgery is recommended in asymptomatic patients with LV dysfunction (LVESD >_40 mm and/or LVEF <_60%).277,286,292 | |
| p.29 | IIa | B | Surgery should be considered in asymptomatic patients with preserved LV function (LVESD <40 mm and LVEF >60%) and AF secondary to mitral regurgitation or pulmonary hypertensionc (SPAP at rest >50 mmHg).285,289 | |
| p.30 | IIa | B | Surgical mitral valve repair should be considered in low-risk asymptomatic patients with LVEF >60%, LVESD <40 mmd and significant LA dilatation (volume index >_60 mL/m2 or diameter >_55 mm) when performed in a Heart Valve Centre and a durable repair is likely.285,288 | |
| p.30 | IIb | B | TEER may be considered in symptomatic patients who fulfil the echocardiographic criteria of eligibility, are judged inoperable or at high surgical risk by the Heart Team and for whom the procedure is not considered futile.299302 | |
| p.32 | I | B | Valve surgery/intervention is recommended only in patients with severe SMR who remain symptomatic despite GDMT (including CRT if indicated) and has to be decided by a structured collaborative Heart Team.247,323,336,337 | |
| p.32 | I | B | disease requiring treatment Valve surgery is recommended in patients undergoing CABG or other cardiac surgery.329,330,333 In symptomatic patients, who are judged not | |
| p.32 | IIa | C | appropriate for surgery by the Heart Team on the basis of their individual characteristics,d PCI (and/or TAVI) possibly followed by TEER (in case of persisting severe SMR) should be considered. | |
| p.32 | IIa | B | ........................................................................................................................................................... disease requiring treatment TEER should be considered in selected symptomatic patients, not eligible for surgery and fulfill- ing criteria suggesting an increased chance of responding to the treatment.337,338,356,357 e | |
| p.32 | IIb | C | Valve surgery may be considered in symptomatic patients judged appropriate for surgery by the Heart Team. | |
| p.32 | IIb | C | In high-risk symptomatic patients not eligible for surgery and not fulfilling the criteria suggesting an increased chance of responding to TEER, the Heart Team may consider in selected cases a TEER procedure or other transcatheter valve therapy if applicable, after careful evaluation for ventricular assist device or heart transplant.e | |
| p.34 | I | B | PMC is recommended in symptomatic patients without unfavourable characteristicsc for PMC.360,363365,367 | |
| p.34 | I | C | PMC is recommended in any symptomatic patients with a contraindication or a high risk for surgery. | |
| p.34 | I | C | Mitral valve surgery is recommended in sympto- matic patients who are not suitable for PMC in the absence of futility. | |
| p.34 | IIa | C | PMC should be considered as initial treatment in symptomatic patients with suboptimal anat- omy but no unfavourable clinical characteristics for PMC.c PMC should be considered in asymptomatic | |
| p.34 | IIa | C | ............................................................................................................................................................................ patients without unfavourable clinical and ana- tomical characteristicsc for PMC and: • High thromboembolic risk (history of systemic embolism, dense spontaneous contrast in the LA, new-onset or paroxysmal AF), and/or • High risk of haemodynamic decompensation (systolic pulmonary pressure >50mmHg at rest, need for major NCS, desire for pregnancy). | |
| p.39 | I | C | Surgery is recommended in symptomatic patients with severe tricuspid stenosis.c | |
| p.39 | I | C | Recommendations on tricuspid stenosis Surgery is recommended in patients with severe tricuspid stenosis undergoing left-sided valve intervention.d | |
| p.39 | I | C | Surgery is recommended in patients with severe primary tricuspid regurgitation undergoing left- sided valve surgery. | |
| p.39 | I | C | Surgery is recommended in symptomatic patients with isolated severe primary tricuspid regurgitation without severe RV dysfunction. | |
| p.39 | IIa | C | Surgery should be considered in patients with moderate primary tricuspid regurgitation under- going left-sided valve surgery. | |
| p.39 | IIa | C | Surgery should be considered in asymptomatic or mildly symptomatic patients with isolated severe primary tricuspid regurgitation and RV dilatation who are appropriate for surgery. | |
| p.39 | I | B | ............................................................................................................................................................................ Surgery is recommended in patients with severe secondary tricuspid regurgitation undergoing left-sided valve surgery.423427 | |
| p.39 | IIa | B | Surgery should be considered in patients with mild or moderate secondary tricuspid regurgita- tion with a dilated annulus (>_40 mm or >21 mm/m2 by 2D echocardiography) undergoing left-sided valve surgery.423,425427 | |
| p.39 | IIa | B | Surgery should be considered in patients with severe secondary tricuspid regurgitation (with or without previous left-sided surgery) who are symptomatic or have RV dilatation, in the absence of severe RV or LV dysfunction and severe pulmonary vascular disease/hyperten- sion.418,433 e | |
| p.39 | IIb | C | Transcatheter treatment of symptomatic secon- dary severe tricuspid regurgitation may be considered in inoperable patients at a Heart Valve Centre with expertise in the treatment of tricus- pid valve disease.f | |
| p.40 | I | C | A mechanical prosthesis is recommended in patients at risk of accelerated SVD.d | |
| p.40 | I | C | Mechanical prostheses A mechanical prosthesis is recommended according to the desire of the informed patient and if there are no contraindications to long- term anticoagulation.c | |
| p.40 | IIa | C | A mechanical prosthesis should be considered in patients already on anticoagulation because of a mechanical prosthesis in another valve position. | |
| p.40 | IIa | B | A mechanical prosthesis should be considered in patients aged <60 years for prostheses in the aortic position and aged <65 years for prostheses in the mitral position.462, 464 e | |
| p.40 | IIa | C | A mechanical prosthesis should be considered in patients with a reasonable life expectancy for whom future redo valve surgery or TAVI (if appropriate) would be at high risk.f | |
| p.40 | IIb | C | A mechanical prosthesis may be considered in patients already on long-term anticoagulation due to the high risk for thromboembolism.f | |
| p.40 | I | C | Biological prostheses A bioprosthesis is recommended according to the desire of the informed patient. A bioprosthesis is recommended when good- | |
| p.40 | I | C | quality anticoagulation is unlikely (adherence problems, not readily available), contraindicated because of high bleeding risk (previous major bleed, comorbidities, unwillingness, adherence problems, lifestyle, occupation) and in those patients whose life expectancy is lower than the | |
| p.40 | I | C | presumed durability of the bioprosthesis.g A bioprosthesis is recommended in case of reoperation for mechanical valve thrombosis despite good long-term anticoagulant control. | |
| p.40 | IIa | C | ............................................................................................................................................................................ A bioprosthesis should be considered in patients for whom there is a low likelihood and/or a low operative risk of future redo valve surgery. | |
| p.40 | IIa | C | A bioprosthesis should be considered in young women contemplating pregnancy. | |
| p.40 | IIa | C | A bioprosthesis should be considered in patients aged >65 years for a prosthesis in the aortic position or aged >70 years in a mitral position. | |
| p.40 | IIb | B | A bioprosthesis may be considered in patients already on long-term NOACs due to the high risk for thromboembolism.466469 f | |
| p.42 | I | B | LMWH are recommended for bridging.476,504 | |
| p.42 | I | C | period It is recommended that VKAs are timely discon- tinued prior to elective surgery to aim for an INR <1.5.c Bridging of OAC, when interruption is needed, is | |
| p.42 | I | C | recommended in patients with any of the following indications: • Mechanical prosthetic heart valve. • AF with significant mitral stenosis. • AF with a CHA2DS2-VASc score >_3 for women or 2 for men.d • Acute thrombotic event within the previous 4 weeks. • High acute thromboembolic risk.e | |
| p.42 | I | C | Therapeutic doses of either UFH or subcutaneous In patients with MHVs, it is recommended to (re)- initiate the VKA on the first postoperative day. | |
| p.43 | I | B | all patients with an MHV prosthesis.472,473 | |
| p.43 | III | B | NOACs are not recommended in patients with a mechanical valve prosthesis.474 | |
| p.43 | I | B | who have other indications for OAC.501 f | |
| p.43 | III | B | Routine use OAC is not recommended after TAVI in patients with no baseline indication for OAC.497 | |
| p.43 | I | C | In patients who have undergone valve surgery with an indication for postoperative therapeutic bridging, it is recommended to start either UFH or LMWH 1224 h after surgery. | |
| p.43 | I | C | In patients undergoing surgery, it is recom- mended that aspirin therapy, if indicated, is maintained during the periprocedural period. In patients treated with DAPT after recent PCI | |
| p.43 | I | C | (within 1 month) who need to undergo heart valve surgery in the absence of an indication for OAC, it is recommended to resume the P2Y12 inhibitor postoperatively, as soon as there is no concern over bleeding. | |
| p.43 | IIb | C | In patients treated with DAPT after recent PCI (within 1 month) who need to undergo heart valve surgery in the absence of an indication for OAC, bridging P2Y12 inhibitors with short-acting glycoprotein IIb/IIIa inhibitors or cangrelor may be considered. | |
| p.43 | I | B | After uncomplicated PCI or ACS in patients requiring long-term OAC, early cessation (<_1 week) of aspirin and continuation of dual therapy with OAC and a P2Y12 inhibitor (pref- erably clopidogrel) for up to 6 months (or up to 12 months in ACS) is recommended if the risk of stent thrombosis is low or if concerns about bleeding risk prevail over concerns about risk of | |
| p.43 | I | B | stent thrombosis, irrespective of the type of stent used.505509 Discontinuation of antiplatelet treatment in patients treated with an OAC is recommended after 12 months.74,510512 After uncomplicated PCI or ACS in patients | |
| p.43 | IIa | C | requiring both OAC and antiplatelet therapy, tri- ple therapy with aspirin, clopidogrel and OAC for longer than 1 week should be considered when the risk of stent thrombosis outweighs the risk of bleeding, with the total duration (<_1 month) decided according to assessment of these risks and clearly specified at hospital | |
| p.43 | IIa | B | discharge. In patients treated with a VKA (e.g. MHVs), clopidogrel alone should be considered in selected patients (e.g. HAS-BLED >_3 or ARC-HBR met and low risk of stent thrombosis) for up to 12 months.512,513 | |
| p.43 | IIa | B | In patients requiring aspirin and/or clopidogrel in addition to VKA, the dose intensity of VKA should be considered and carefully regulated with a target INR in the lower part of the rec- ommended target range and a time in the therapeutic range >6570%.505,514 Surgical valve replacement OAC using a VKA is recommended lifelong for | |
| p.43 | I | B | For patients with a VKA, INR self-management is recommended provided appropriate training and quality control are performed.482 | |
| p.43 | I | C | OAC is recommended for patients undergoing implantation of a surgical BHV who have other indications for anticoagulation.f | |
| p.43 | IIa | B | NOACs should be considered over VKA after 3 months following surgical implantation of a BHV in patients with AF.74,499,500,515518 | |
| p.43 | IIa | B | In patients with no baseline indications for OAC, low-dose aspirin (75100 mg/day) or OAC using a VKA should be considered for the first 3 months after surgical implantation of an aortic BHV.491,494 | |
| p.43 | IIa | B | In patients with no baseline indications for OAC, OAC using a VKA should be considered for the first 3 months after surgical implantation of a bio- prosthesis in the mitral or tricuspid position.519,520 | |
| p.43 | IIb | C | The addition of low-dose aspirin (75100 mg/ day) to VKA may be considered in selected patients with MHVs in case of concomitant atherosclerotic disease and low risk of bleeding. | |
| p.43 | IIa | C | The addition of low-dose aspirin (75100 mg/ day) to VKA should be considered after throm- boembolism despite an adequate INR. | |
| p.43 | IIb | C | ................................................................................................................................................................................ NOACs may be considered over VKA within 3 months following surgical implantation of a BHV in mitral position in patients with AF.499 | |
| p.43 | IIa | C | Surgical valve repair OAC with VKA should be considered during the first 3 months after mitral and tricuspid repair. | |
| p.43 | IIa | C | SAPT with low-dose ASA (75100 mg/day) should be considered for the first 3 months after valve-sparing aortic surgery when there are no other baseline indications to OAC. Transcatheter aortic valve implantation | |
| p.43 | I | A | OAC is recommended lifelong for TAVI patients Lifelong SAPT is recommended after TAVI in patients with no baseline indication for OAC.495,496,521 | |
| p.46 | I | B | Mechanical prosthetic thrombosis Urgent or emergency valve replacement is rec- ommended for obstructive thrombosis in critically ill patients without serious comorbidity.542 Fibrinolysis (using recombinant tissue plasmino- | |
| p.46 | IIa | B | gen activator 10 mg bolus þ 90 mg in 90 min with UFH or streptokinase 1 500 000 U in 60 min without UFH) should be considered when sur- gery is not available or is very high risk, or for thrombosis of right-sided prostheses.542 | |
| p.47 | IIa | C | Surgery should be considered for large (>10 mm) non-obstructive prosthetic thrombus complicated by embolism. | |
| p.47 | I | C | Bioprosthetic thrombosis Anticoagulation using a VKA and/or UFH is rec- ommended in bioprosthetic valve thrombosis before considering re-intervention. | |
| p.47 | IIa | B | Anticoagulation should be considered in patients with leaflet thickening and reduced leaflet motion leading to elevated gradients, at least until resolution.541,546 | |
| p.47 | I | C | Haemolysis and paravalvular leak Reoperation is recommended if a paravalvular leak is related to endocarditis or causes haemolysis requiring repeated blood transfusions or leading to severe heart failure symptoms. | |
| p.47 | IIa | B | Transcatheter closure should be considered for suitable paravalvular leaks with clinically significant regurgitation and/or haemolysis in patients at high or prohibitive surgical risk.547 | |
| p.47 | IIa | C | Decision on transcatheter or surgical closure of clinically significant paravalvular leaks should be considered based on patient risk status, leak morphology, and local expertise. | |
| p.47 | I | C | Bioprosthetic failure Reoperation is recommended in symptomatic patients with a significant increase in transpros- thetic gradient (after exclusion of valve thrombosis) or severe regurgitation. | |
| p.47 | IIa | B | Transcatheter, transfemoral valve-in-valve implantation in the aortic position should be considered by the Heart Team depending on anatomic considerations, features of the pros- thesis, and in patients who are at high operative risk or inoperable.529 | |
| p.47 | IIb | B | Transcatheter valve-in-valve implantation in the mitral and tricuspid position may be considered in selected patients at high risk for surgical reintervention.382,531,532 | |
| p.47 | IIa | C | Reoperation should be considered in asympto- matic patients with significant prosthetic dys- function if reoperation is low risk. UFH = unfractionated heparin; VKA = vitamin K antagonist. aClass of recommendation. bLevel of evidence. | |
| p.51 | I | C | Coronary angiography is recommended in the evaluation of severe SMR. | |
| p.51 | III | C | The use of NOACs is not recommended in patients with AF and moderate to severe mitral stenosis. | |
| p.51 | I | B | Surgery is recommended in symptomatic patients regardless of LV function. | |
| p.52 | I | B | Mitral valve repair is the recommended surgical technique when the results are expected to be durable. | |
| p.52 | I | B | Surgery is recommended in symptomatic patients who are operable and not high risk. | |
| p.52 | I | B | Surgery is recommended in asymptomatic patients with LV dysfunction (LVESD >_40 mm and/or LVEF <_60%). | |
| p.52 | I | B | Valve surgery is recommended in patients undergoing CABG or other cardiac surgery. | |
| p.52 | I | B | PMC is recommended in symptomatic patients without unfavourable characteristics for PMC. | |
| p.52 | I | C | PMC is recommended in any symptomatic patients with a contraindication or a high risk for surgery. | |
| p.52 | I | C | Mitral valve surgery is recommended in symptomatic patients who are not suitable for PMC in the absence of futility. | |
| p.52 | I | C | Surgery is recommended in symptomatic patients with severe tricuspid stenosis. | |
| p.52 | I | C | Surgery is recommended in patients with severe tricuspid stenosis undergoing left-sided valve intervention. | |
| p.52 | I | C | Surgery is recommended in patients with severe primary tricuspid regurgitation undergoing left-sided valve surgery. | |
| p.52 | I | B | Surgery is recommended in patients with severe secondary tricuspid regurgitation undergoing left-sided valve surgery. | |
| p.52 | I | C | A mechanical prosthesis is recommended in patients at risk of accelerated SVD. | |
| p.52 | I | C | A bioprosthesis is recommended according to the desire of the informed patient. | |
| p.53 | I | C | It is recommended that VKAs are timely discontinued prior to elective surgery to aim for an INR <1.5. | |
| p.53 | I | B | Therapeutic doses of either UFH or subcutaneous LMWH are recommended for bridging. | |
| p.53 | I | C | In patients with MHVs, it is recommended to (re)-initiate the VKA on the first postoperative day. | |
| p.53 | I | B | Discontinuation of antiplatelet treatment in patients treated with an OAC is recommended after 12 months. | |
| p.53 | I | B | OAC using a VKA is recommended lifelong for all patients with a MHV prosthesis. | |
| p.53 | III | B | NOACs are not recommended in patients with an MHV. | |
| p.53 | I | B | OAC is recommended lifelong for TAVI patients who have other indications for anticoagulation. | |
| p.53 | I | A | Lifelong SAPT is recommended after TAVI in patients with no baseline indication for OAC. | |
| p.53 | III | B | Routine use of OAC is not recommended after TAVI in patients who have no baseline indication for OAC. |