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Table 3 Continued

New or Revised Recommendations in 2017 version Class Recommendations in 2021 version Class Section 8: Indications for intervention in secondary tricuspid regurgitation Revised After previous left-sided surgery and in absence of

recurrent left-sided valve dysfunction, surgery should be considered in patients with severe tricuspid regurgitation who are symptomatic or have progressive RV dilatation/dysfunction, in the absence of severe RV or LV dysfunction and severe pulmonary vascular disease/hypertension. IIa 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/hypertension. IIa

New 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 tricuspid valve disease. IIb

Section 11. Recommendations for prosthetic valve selection New A bioprosthesis may be considered in patients already on long-term NOACs due to the high risk

for thromboembolism. IIb

Revised A bioprosthesis should be considered in those (patients) whose life expectancy is lower than the

presumed durability of the bioprosthesis.

IIa A bioprosthesis is recommended when good-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 presumed durability of the bioprosthesis. I

Section 11. Recommendations for perioperative and postoperative antithrombotic management of valve replacement or repair Management of antithrombotic therapy in the perioperative period New Bridging of OAC, when interruption is needed, is

recommended in patients with any of the following indication:

• Mechanical prosthetic heart valve. • AF with significant mitral stenosis. • AF with a CHA2DS2-VASc score >_3 for

women or 2 for men. • Acute thrombotic event within the previous 4 weeks. • High acute thromboembolic risk. I

New It is recommended that VKAs are timely discontinued prior to elective surgery to aim for an INR

<1.5. I

New In patients undergoing surgery, it is recommended

that aspirin therapy, if indicated, is maintained during the periprocedural period. I

New In patients who have undergone valve surgery with

an indication for postoperative therapeutic bridging, it is recommended to start either UFH or LMWH 1224 hours after surgery. I

New In patients with MHVs, it is recommended to (re)-

initiate VKAs on the first postoperative day. I

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