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21 Evidence tables

Evidence tables are available at European Heart Journal online.

22 Data availability statement

No new data were generated or analysed in support of this research.

23 Author information

Jonas Lanz, Department of Cardiology, Bern University Hospital, Bern, Switzerland; Mateo Marin-Cuartas, University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Ana Abreu, Faculdade de Medicina da Universidade de Lisboa (FMUL), ISAMB, IMPSP, CCUL, CAML, Lisboa, Portugal; Serviço Cardiologia, Unidade de Reabilitação Cardiovascular, ULS Santa Maria/FMUL, Lisboa, Portugal; Marianna Adamo, Institute of Cardiology, ASST Spedali Civili, Brescia, Italy; Department of medical and surgical specialties, radiological sciences, and public health, University of Brescia, Italy; Nina Ajmone Marsan, Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands; Fabio Barili, Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, Milan, Italy; University Cardiac Surgery Unit, IRCCS Ospedale Galeazzi - Sant’Ambrogio, Milan, Italy; Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, MA, United States of America; Nikolaos Bonaros, Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria; University Hospital Innsbruck, Innsbruck, Austria; Bernard Cosyns, Cardiology department, Universitair Ziekenhuis Brussel, Brussels, Belgium; Ruggero De Paulis, Department of cardiac surgery, European Hospital, Rome, Italy; Unicamillus University, Rome, Italy; Habib Gamra, Cardiology University of Monastir, Monastir, Tunisia; Marjan Jahangiri, Cardiac Surgery, St George’s Hospital, London, United Kingdom; Anders Jeppsson, Cardiothoracic surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Molecular and clinical medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Robert J.M. Klautz, Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands; Benoit Mores, (Belgium), ESC Patient Forum, Sophia Antipolis, France; Esther Pérez-David, Cardiology Department, Hospital Universitario La Paz, IdiPaz (Hospital la Paz Research Institute), Facultad de Medicina Universidad Europea de Madrid, Madrid, Spain; Janine Pöss, Department of internal medicine/cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany; Bernard D. Prendergast, Heart Vascular & Thoracic Institute, Cleveland Clinic London, London, United Kingdom; Department of Cardiology, St Thomas’ Hospital, London, United Kingdom; Bianca Rocca, Department of Medicine and Surgery, LUM University Casamassima (Ba), Italy; Xavier Rossello, Cardiology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Health Research Institute of the Balearic Islands (IdISBa), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain; Mikio Suzuki, (Serbia), ESC Patient Forum, Sophia Antipolis, France; Holger Thiele, Department of Internal Medicine/ Cardiology, Heart Centre Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Science, Leipzig, Germany; Christophe Michel Tribouilloy, Cardiology department, Amiens University Hospital, Amiens, France; and Wojtek Wojakowski, Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

24 Appendix

ESC/EACTS Scientific Document Group Includes Document Reviewers, ESC National Cardiac Societies and EACTS Network of National Cardiac Surgery Societies Document Reviewers: Alec Vahanian (ESC Review Co-ordinator) (France), Carlos-A. Mestres (EACTS Review Co-ordinator) (South Africa), Leila Abid (Tunisia), Suleman Aktaa (United Kingdom), Elena Arbelo (Spain), Folkert W. Asselbergs (Netherlands), Emanuele Barbato (Italy), Giuseppe Boriani (Italy), Margarita Brida (Croatia), Sergio Buccheri (Sweden), Robert Byrne (Republic of Ireland), Ovidiu Chioncel (Romania), Lenard Conradi (Germany), Michele De Bonis (Italy), Victoria Delgado (Spain), Enoch F. Akowuah (United Kingdom), Anna Franzone (Italy), Kristina Hermann Haugaa (Norway), Bettina Heidecker (Germany), Borja Ibanez (Spain), Bernard Iung (France), Stefan James (Sweden), Lars Køber (Denmark), Konstantinos C. Koskinas (Switzerland), Ulf

Mechanical heart valve thrombosis Heart Team evaluation is recommended in patients with acute HF (NYHA class III or IV) due to obstructive MHV thrombosis to determine appropriate management (repeat valve replacement or low-dose slow infusion fibrinolysis). I B Biological heart valve thrombosis OAC using VKA is recommended in BHV thrombosis before considering reintervention. I B © ESC/EACTS 2025

4D, four-dimensional; AF, atrial fibrillation; AR, aortic regurgitation; AS, aortic stenosis; ASA, acetylsalicylic acid; AV, aortic valve; AVA, aortic valve area; BHV, biological heart valve; BSA, body surface area; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CCTA, coronary CT angiography; CRT, cardiac resynchronization therapy; CT, computed tomography; DAPT, dual antiplatelet therapy; DOAC, direct oral anticoagulation; GDMT, guideline-directed medical therapy; h, hour; HF, heart failure; INR, international normalized ratio; LA, left atrium/ left atrial; LAVI, left atrial volume index; LMWH, low-molecular-weight heparin; LV, left ventricle/left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVESDi, left ventricular end-systolic diameter indexed to BSA; MHV, mechanical heart valve; MR, mitral regurgitation; MS, mitral stenosis; MV, mitral valve; MVA, mitral valve area; NCS, non-cardiac surgery; NYHA, New York Heart Association; OAC, oral anticoagulation; PH, pulmonary hypertension; PMC, percutaneous mitral commissurotomy; PMR, primary mitral regurgitation; PVL, paravalvular leak; RV, right ventricle/right ventricular; SAVR, surgical aortic valve replacement; SMR, secondary mitral regurgitation; SPAP, systolic pulmonary artery pressure; SVi, stroke volume index; TAVI, transcatheter aortic valve implantation; TEER, transcatheter edge-to-edge repair; TOE, transoesophageal echocardiography; TR, tricuspid regurgitation; TS, tricuspid stenosis; TV, tricuspid valve; UFH, unfractionated heparin; VKA, vitamin K antagonist; Vmax, peak transvalvular velocity. aClass of recommendation. bLevel of evidence. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026