Understanding Heart Valve Disease
Heart valve disease (VHD) affects the valves that control blood flow through the heart. These valves can become too narrow (stenosis) or leaky (regurgitation), making it harder for the heart to pump blood effectively. Common symptoms include shortness of breath, fatigue, chest pain, and dizziness—but sometimes, people may not feel any symptoms at all.
The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have released updated guidelines in 2025 to help doctors diagnose and treat VHD more effectively.
Key Updates in the 2025 Guidelines
- Team-Based Care
The guidelines emphasise the importance of a Heart Team—a group of specialists, including cardiologists, surgeons, and imaging experts—working together to decide the best treatment for each patient. This ensures that care is personalised and based on the latest evidence.
- Advanced Imaging
Doctors now rely more on advanced imaging techniques, such as echocardiography, CT scans, and MRI, to better understand the structure and function of the heart valves. This helps in making more accurate diagnoses and choosing the right treatment.
Aortic Valve Stenosis: Earlier Treatment Recommended
What is it?
Aortic stenosis occurs when the valve between your heart and the aorta becomes stiff and narrow, making it harder for blood to flow out of the heart.
What’s new?
- Early treatment is now encouraged, even if you don’t have symptoms, especially if tests show your heart is under strain or the valve is heavily calcified.
- TAVI (Transcatheter Aortic Valve Implantation), a less invasive procedure, is now recommended for patients aged 70 and older, regardless of surgical risk, if the valve anatomy is suitable.
- Open-heart surgery remains the preferred option for younger, healthier patients, especially those with a bicuspid valve (a valve with two flaps instead of three).
Mitral Valve Regurgitation: Acting Sooner to Protect the Heart
What is it?
Mitral regurgitation (MR) happens when the mitral valve doesn’t close properly, allowing blood to leak backwards into the heart’s upper chamber.
Types:
- Primary MR: Caused by problems with the valve itself.
- Secondary MR: Caused by other heart conditions affecting valve function.
What’s new?
- Early surgery is now strongly recommended for patients with severe primary MR, even if they feel fine, if they have:
- Atrial fibrillation (irregular heartbeat)
- High pressure in the lungs
- An enlarged left atrium
- Transcatheter edge-to-edge repair (TEER) is now more widely recommended for high-risk patients with secondary MR and heart failure. This procedure can reduce hospital visits and improve quality of life.
Tricuspid Valve Disease: New Treatment Options
What is it?
The tricuspid valve regulates blood flow between the right atrium and the right ventricle of the heart. Tricuspid regurgitation (TR) means this valve leaks, causing blood to flow backwards.
What’s new?
- Surgery or transcatheter treatment is now recommended for patients with moderate or severe TR who are undergoing other heart valve surgeries.
- For high-risk patients with severe TR, transcatheter treatments may improve symptoms and heart function.
Special Considerations
- Sex-Specific Care
The guidelines now include recommendations tailored to men and women, recognising that heart valve disease can affect them differently.
- Cancer Patients
There’s new guidance for managing valve disease in people with cancer, especially those who’ve had radiation therapy.
- Multiple Valve Problems
If you have more than one valve affected, doctors now have more precise recommendations on how to prioritise treatment and follow-up.
What This Means for You
If you have—or are at risk for—heart valve disease, these updated guidelines mean:
- Earlier diagnosis and treatment may be recommended, even if you feel well.
- Less invasive procedures like TAVI and TEER are now available to more patients.
- Your care will likely involve a team of specialists working together.
- Your personal health, age, heart anatomy, and preferences will guide treatment decisions.
Questions to Ask Your Doctor
- Do I have heart valve disease, and how severe is it?
- Am I a candidate for early treatment?
- Would a less invasive procedure like TAVI or TEER be right for me?
- What are the risks and benefits of surgery versus transcatheter options?
- How will my other health conditions affect my treatment plan?
Final Thoughts
The 2025 ESC/EACTS guidelines represent a significant advancement in the management of heart valve disease. With a focus on early intervention, personalised care, and advanced technology, patients can expect better outcomes and improved quality of life.
If you or a loved one has been diagnosed with heart valve disease, talk to your healthcare provider about how these new recommendations may apply to your situation.
- References
- Fabien Praz, Michael A Borger, Jonas Lanz, Mateo Marin-Cuartas, Ana Abreu, Marianna Adamo, Nina Ajmone Marsan, Fabio Barili, Nikolaos Bonaros, Bernard Cosyns, Ruggero De Paulis, Habib Gamra, Marjan Jahangiri, Anders Jeppsson, Robert J M Klautz, Benoit Mores, Esther Pérez-David, Janine Pöss, Bernard D Prendergast, Bianca Rocca, Xavier Rossello, Mikio Suzuki, Holger Thiele, Christophe Michel Tribouilloy, Wojtek Wojakowski, ESC/EACTS Scientific Document Group , 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), European Heart Journal, 2025;, ehaf194, doi.org/10.1093/eurheartj/ehaf194
9-UK-5-16505-01 09-2025 REV A