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............................................................. Task Force. Although the principle activities of the group concerned the chapter on aortic stenosis and SMR, it was not limited to these two domains. The methodology group was at disposal, upon request of the Task Force members, to resolve specific methodological issues.

2.3 Content of these guidelines

Decision making in VHD involves accurate diagnosis, timing of intervention, risk assessment and, based on these, selection of the most suitable type of intervention. These guidelines focus on acquired VHD, are oriented towards management, and do not deal with endocarditis,4 congenital valve disease5 (including pulmonary valve disease), or recommendations concerning sports cardiology and exercise in patients with cardiovascular disease,6 as separate guidelines have been published by the ESC on these topics.

2.4 New format of the guidelines

The new guidelines have been adapted to facilitate their use in clinical practice and to meet readers’ demands by focusing on condensed, clearly represented recommendations. At the end of the document, key points summarize the essentials. Gaps in evidence are listed to propose topics for future research. The guideline document will be harmonized with the chapter on VHD included in the ESC Textbook of Cardiovascular Medicine (ISBN: 9780198784906). The guidelines and the textbook are complementary. Background information and detailed discussion of the data that have provided the basis for the recommendations will be found in the relevant book chapter.

2.5 How to use these guidelines

The Committee emphasizes that many factors ultimately determine the most appropriate treatment in individual patients within a given community. These factors include the availability of diagnostic equipment, the expertise of cardiologists and surgeons, especially in the field of valve repair and percutaneous intervention, and, notably, the wishes of well-informed patients. Furthermore, owing to the lack of evidence-based data in the field of VHD, most recommendations are largely the result of expert consensus opinion. Therefore, deviations from these guidelines may be appropriate in certain clinical circumstances.

Table 3 Continued

New or Revised Recommendations in 2017 version Class Recommendations in 2021 version Class Transcatheter Aortic Valve Implantation New OAC is recommended lifelong for TAVI patients

who have other indications for OAC. I

Revised SAPT may be considered after TAVI in the case of

high bleeding risk. IIb Lifelong SAPT is recommended after TAVI in

patients with no baseline indication for OAC. I

New Routine use of OAC is not recommended after

TAVI in patients with no baseline indication for OAC. III

Section 11. Recommendations on management of prosthetic valve dysfunction Haemolysis and paravalvular leak New Decision on transcatheter or surgical closure of

clinically significant paravalvular leaks should be considered based on patient risk status, leak morphology, and local expertise. IIa

Bioprosthetic thrombosis New Anticoagulation should be considered in patients

with leaflet thickening and reduced leaflet motion leading to elevated gradients, at least until resolution. IIa

Bioprosthetic failure New Transcatheter valve-in-valve implantation in the mitral and tricuspid position may be considered in

selected patients at high-risk for surgical reintervention. IIb

ACS = acute coronary syndrome; AF = atrial fibrillation; ARC-HBR = Academic Research Consortium - high bleeding risk; BHV = biological heart valve; BNP = B-type natriuretic peptide; BSA = body surface area; CABG = Coronary artery bypass grafting; CCT = cardiac computed tomography; CRT = cardiac resynchronization therapy; DAPT = dual antiplatelet therapy; EuroSCORE = European System for Cardiac Operative Risk Evaluation; GDMT = guideline-directed medical therapy; INR = international normalized ratio; LA = left atrium/left atrial; LAA = left atrial appendage; LMWH = low-molecular-weight heparin; LV = left ventricle/left ventricular; LVEDD = left ventricular end-diastolic diameter; LVEF = left ventricular ejection fraction; LVESD = Left ventricular end-systolic diameter; MHV = mechanical heart valve; NOAC = non-vitamin K antagonist oral anticoagulant; OAC = oral anticoagulation; PCI = percutaneous coronary intervention; RV = right ventricle/right ventricular; SAPT = single antiplatelet therapy; SAVR = surgical aortic valve replacement; SMR = secondary mitral regurgitation; SPAP = systolic pulmonary arterial pressure; STS-PROM = Society of Thoracic Surgeons - predicted risk of mortality; TAVI = transcatheter aortic valve implantation; TEER = transcatheter edge-to-edge repair; UFH = unfractionated heparin; VHD = valvular heart disease; VKA = vitamin K antagonist; Vmax = peak transvalvular velocity. ESC/EACTS 2021 Downloaded from academic.oup.com/eurheartj/article/43/7/561/6358470 by guest on 07 October 2026