Guidelines for the management of valvular heart disease

31 August 2021

The European Association for Cardio-Thoracic Surgery (EACTS) and European Society of Cardiology (ESC) Guidelines for the management of valvular heart disease were published online in the European Journal of Cardio-Thoracic Surgery on Saturday 28th of August 2021.

EACTS is proud of this collaborative joint guideline, including all members of the Heart Team. A discussion within the Heart Team should be the basis of all treatment decisions. This recommendation should be discussed with the patient, who can then make an informed decision.

We recognise there is considerable interest in the use of age cut-offs to assist in the choice of intervention for aortic stenosis. The evidence favours SAVR in some patients, TAVI in others, and either mode of intervention can be used for those in between. The Heart Team discussion is central in the care of these patients, and the guideline (table 6) details the clinical, anatomical and procedural factors that influence the choice of treatment modality for an individual patient.

Randomised controlled trials comparing SAVR to TAVI have included patients based on estimated risk, not age, and there has been no evidence of interaction between age and outcomes. Life expectancy for an individual patient is difficult to estimate; it varies widely across the world and is dependent on absolute age, sex, frailty, and the presence of comorbidities. Age was chosen as surrogate, considering the interplay between estimated life expectancy and prosthetic heart valve durability.

Despite the lack of evidence for age in determining intervention modality, it has been used in several other recent recommendations. The 2017 ESC/EACTS valvular heart disease guidelines already proposed an age limit of 75 as cut-off (in table 7). The ACC/AHA 2020 guidelines recommend TAVR >80, SAVR <65 and a Heart Team discussion for patients in between. The German Cardiology and Cardiac Surgery Associations’ consensus statement proposes SAVR for low-risk patients ≤70, TAVI for patients ≥75, and a Heart Team discussion for patients in between. The age cut-offs agreed-upon in the ESC/EACTS guidelines can be considered conservative in comparison and were the subject of intense and constructive discussions. As there are no new data regarding age since the 2017 ESC/EACTS guideline, the same age of 75 years was used as in the previous iteration.

The guidelines have advanced other areas. Increased experience and procedural safety have led to expanded indications toward earlier surgery in asymptomatic patients with aortic stenosis, aortic regurgitation and mitral regurgitation. Furthermore, these joint guidelines inaugurated the contribution of a methodology group. We are encouraged to expand the use of this group to all guidelines and putting into place an open process, with independent review of the evidence using validated tools such as the GRADE system, and avoiding conflicts of interest.

We look forward to a continuing fruitful collaboration on these joint guidelines with our colleagues from ESC, advancing a common European perspective on the evidence. These guidelines should be a living document, updated as new data is made available with longer follow-up, particularly in the low-risk trials.

A video summary of advances in these guidelines can be seen on ESC TV (, as well as the live session at ESC Congress (for registered users: A session with Heart Team members of the Taskforce will provide insight during the 35th EACTS Annual Meeting in Barcelona on October 14th

Rafael Sádaba, EACTS Secretary General

Friedhelm Beyersdorf, Chair of the EACTS Task Force for the ESC/EACTS Guidelines on Heart Valve Disease

Vacancy – Publications Director

Circa £50,000pa full-time, permanent

EACTS, Windsor, UK.

The European Association for Cardio-Thoracic Surgery is Europe’s largest and leading membership Society for surgeons, perfusionists and health care professionals involved in cardiothoracic care and treatments. We are active in more than 50 countries worldwide and boast an engaged membership of 4,000.

Over the coming years, we will be growing the reach, impact and influence of the Association globally and our publications portfolio is a key element in our planning.  We now wish to appoint our first Publications Director to be responsible for the operational activities and strategic development of our two world-leading journals, the EJCTS and the ICTVS.

This role is ideally suited for an ambitious and strategic professional with a meticulous eye for detail. You will have at least a working knowledge of one of the major journal submissions systems such as Editorial Manager or ScholarOne and enjoy excellent time-management, communication and interpersonal skills.  A salary of circa £50,000 plus pension and benefits and a central Windsor based office location are on offer for the ideal candidate with remote, flexible working considered.


Please click on the link below to download the full Candidate Brief including Job Description.

Applications should consist of a full CV and a supporting letter, which should address key aspects of the responsibilities outlined here and the candidate’s personal suitability for the role.

Completed applications should be emailed to:  [email protected]
Closing date for applications: 24 September 2021
The appointment will be made subject to satisfactory references.