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2025 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: Fabien Praz  *†, (ESC Chairperson) (Switzerland), Michael A. Borger  *†, (EACTS Chairperson) (Germany), Jonas Lanz ‡, (ESC Task Force Co-ordinator) (Switzerland), Mateo Marin-Cuartas ‡, (EACTS Task Force Co-ordinator) (Germany), Ana Abreu (Portugal), Marianna Adamo (Italy), Nina Ajmone Marsan (Netherlands), Fabio Barili (Italy), Nikolaos Bonaros (Austria), Bernard Cosyns (Belgium), Ruggero De Paulis (Italy), Habib Gamra (Tunisia), Marjan Jahangiri (United Kingdom), Anders Jeppsson (Sweden), Robert J.M. Klautz (Netherlands), Benoit Mores (Belgium), Esther Pérez-David (Spain), Janine Pöss (Germany), Bernard D. Prendergast (United Kingdom), Bianca Rocca (Italy), Xavier Rossello (Spain), Mikio Suzuki (Serbia), Holger Thiele (Germany), Christophe Michel Tribouilloy (France), Wojtek Wojakowski (Poland), and ESC/EACTS Scientific Document Group * Corresponding authors: Fabien Praz, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Tel: +41 31 632 83 50, Email: fabien.praz@insel.ch and Michael A. Borger, University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany, Tel: +49 341 865 1422, Email: michael.borger@helios-gesundheit.de † The two Chairpersons contributed equally to the document and are joint corresponding authors. ‡ The two Task Force Co-ordinators contributed equally to the document. Author/Task Force Member affiliations are listed in author information. ESC Clinical Practice Guidelines (CPG) Committee: listed in the Appendix. 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 Preventive Cardiology (EAPC), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), and Heart Failure Association (HFA) Working Groups: Cardiovascular Pharmacotherapy Patient Forum Disclaimer. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (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 judgement, 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 prior to making any clinical decision and to check whether a more recent version of this document exists. The ESC and the EACTS warn readers that the technical language may be misinterpreted and decline any responsibility in this respect. Permissions. The content of these ESC/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. Permissions 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). This article has been co-published with permission in the European Heart Journal and European Journal of Cardio-Thoracic Surgery. All rights reserved. © The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery 2025. 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. 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.

European Heart Journal (2025) 46, 4635–4736 https://doi.org/10.1093/eurheartj/ehaf194

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