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2021 ESC/EACTS Guidelines for the management of valvular heart disease Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Authors/Task Force Members: Alec Vahanian * (ESC Chairperson) (France), Friedhelm Beyersdorf*1 (EACTS Chairperson) (Germany), Fabien Praz (ESC Task Force Coordinator) (Switzerland), Milan Milojevic1 (EACTS Task Force Coordinator) (Serbia), Stephan Baldus (Germany), Johann Bauersachs (Germany), Davide Capodanno (Italy), Lenard Conradi1 (Germany), Michele De Bonis1 (Italy), Ruggero De Paulis1 (Italy), Victoria Delgado (Netherlands), Nick Freemantle1 (United Kingdom), Martine Gilard (France), Kristina H. Haugaa (Norway), Anders Jeppsson1 (Sweden), Peter Ju ̈ni (Canada), Luc Pierard (Belgium), Bernard D. Prendergast (United Kingdom), J. Rafael Sadaba1 (Spain), Christophe Tribouilloy (France), Wojtek Wojakowski (Poland), ESC/EACTS Scientific Document Group * Corresponding authors: Alec Vahanian, UFR Medecine, Universite ́ de Paris, site Bichat, 16 rue Huchard, 75018 Paris, France; and LVTS INSERM U1148, GH Bichat, 46, rue Henri Huchard, 75018 Paris, France. Tel: þ 33 6 63 15 56 68, E-mail: alec.vahanian@gmail.com; Friedhelm Beyersdorf, Department of Cardiovascular Surgery, University Heart Center, University Hospital Freiburg, Germany; and Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany, Hugstetterstr. 55, D-79106 Freiburg, Germany. Tel: þ49 761 270 28180. E-mail: friedhelm.beyersdorf@uniklinik-freiburg.de Author/Task Force Member affiliations: listed in Author information. ESC Clinical Practice Guidelines Committee (CPG): listed in the Appendix. EACTS Council: listed in the Appendix. 1Representing the European Association for Cardio-Thoracic Surgery (EACTS) ESC subspecialty communities having participated in the development of this document: Associations: Association for Acute CardioVascular Care (ACVC), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). Councils: Council on Valvular Heart Disease. Working Groups: Cardiovascular Surgery, Thrombosis. Patient Forum The content of these European Society of Cardiology (ESC) / European Association for Cardio-Thoracic Surgery (EACTS) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC/EACTS Guidelines may be translated or reproduced in any form without written permission from the ESC and the EACTS. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oup.com). Disclaimer: The ESC/EACTS Guidelines represent the views of the ESC and the EACTS and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC and the EACTS are not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC/EACTS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC/EACTS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC/EACTS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC/EACTS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. This article has been co-published with permission in the European Heart Journal and European Journal of Cardio-Thoracic Surgery. V C the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery 2021. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article. For permissions, please email journals.permissions@oup.com. ESC/EACTS GUIDELINES European Heart Journal (2022) 43, 561–632 https://doi.org/10.1093/eurheartj/ehab395 No part of this publication may be reproduced, stored in a retrieval system, transmitted, used for text and data mining, or used for training artificial intelligence, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license or under terms agreed with the appropriate reprographics rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. ESC Guidelines are protected by copyright. As per opt out option under Article 4 §3 of EU Directive 2019/790, the European Society of Cardiology (ESC) reserves all rights to license uses of ESC Guidelines to train or develop generative artificial intelligence (AI) models, large language models or other deep learning or machine learning models. 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