Updated guidance for doctors on heart valve diseases
In 2021, leading heart experts in Europe created updated guidelines to help doctors care for people with heart valve disease. These guidelines explain how to properly diagnose the condition, decide when treatment is needed, and choose the best treatment option. They also highlight the importance of a “heart team” approach—where different specialists work together—and focus on making decisions that are right for each individual patient. This means your personal health, heart anatomy, and the experience of your medical team all play a role in planning your care.
Aortic valve stenosis: guideline advises early intervention
Aortic valve stenosis is the most common heart valve condition in many countries. It happens when the valve between the heart and the main artery (the aorta) becomes stiff and doesn’t open fully. This makes it harder for the heart to pump blood to the rest of the body. Over time, the heart has to work harder, which can lead to symptoms like shortness of breath, chest pain, tiredness, or dizziness.
Sometimes, people don’t notice any symptoms at first. But even without symptoms, severe aortic stenosis can still damage the heart. That’s why doctors may recommend early treatment—especially if tests show the heart is already under strain, the valve is very narrowed, or there’s heavy calcium buildup.
A newer, less invasive procedure called TAVI (Transcatheter Aortic Valve Implantation) is now being used in some patients earlier than previously. Recent studies show that treating the condition before symptoms appear can lead to better long-term outcomes, including fewer hospital visits and a lower risk of serious heart problems.
The latest guidelines now recommend open-heart surgery for patients under 75 who are healthy enough for it and have a low surgical risk. For others, especially those who are older or have other health issues, a less invasive option called TAVI (Transcatheter Aortic Valve Implantation) is often preferred.
Mitral valve: early action can improve quality of life
Mitral regurgitation (MR) happens when the heart’s mitral valve doesn’t close properly, causing blood to leak backward into the upper chamber of the heart. This can reduce the amount of oxygen-rich blood pumped to the body and may lead to symptoms like shortness of breath or fatigue. Over time, it can also cause fluid buildup in the lungs.
There are two main types:
- Primary MR is caused by problems with the valve itself, such as wear and tear, infection, or inherited conditions.
- Secondary MR is due to other heart problems that affect how the valve works.
The latest guidelines recommend earlier treatment for severe primary MR—even before symptoms appear—if:
- The patient has developed atrial fibrillation (irregular heartbeat) or high blood pressure in the lungs.
- The left atrium is enlarged, even if the heart is still pumping well and the patient feels fine.
- Doctors now use more precise measurements to decide when to treat MR, aiming to protect heart function and prevent complications. Surgery is often the first choice if the patient is healthy enough, and newer, less invasive options may be considered for others.
Treating Secondary Mitral Regurgitation
Secondary mitral regurgitation (MR) happens when the heart’s left ventricle becomes enlarged or damaged, even though the valve itself is healthy. As the ventricle stretches, it pulls the valve leaflets apart, causing blood to leak backward into the upper chamber of the heart. This can be caused by conditions like heart muscle inflammation (myocarditis), coronary artery disease, or high blood pressure—often linked to hardened arteries.
The latest guidelines recommend a minimally invasive treatment called the MitraClip™ procedure. In this approach, a small clip is delivered through a vein in the groin to the heart. It gently clips the valve leaflets together, helping them close more effectively—like a tiny clothespin.
Because it doesn’t require open-heart surgery, the MitraClip™ is much easier on the body and has a shorter recovery time. It’s been shown to improve symptoms, enhance quality of life, reduce hospital stays, and even lower the risk of death. In some cases, it can be combined with other treatments if needed.
Tricuspid valve - a frequently underestimated defect
Tricuspid valve regurgitation (TR) is a heart valve condition that has often been overlooked in the past. It happens when the valve between the right side of the heart and the lungs doesn’t close properly. As a result, some blood flows backwards into the heart instead of moving forward to the lungs. This can lead to symptoms like tiredness, swelling, or shortness of breath, and if left untreated, it can put serious strain on the heart and increase the risk of complications or death.
TR often occurs alongside other heart valve problems and can be caused by conditions like pulmonary hypertension (high blood pressure in the lungs).
The good news is that new, less invasive treatments are now available. One option is a catheter-based procedure using a device like the TriClip™. This tiny clip is inserted through a vein in the groin and placed on the valve to help it close more effectively, much like a clothespin. Because it doesn’t require open-heart surgery, recovery is usually quicker and easier.
According to the latest guidelines, this treatment is recommended for people with severe symptoms who can’t have surgery. It should be done at specialised heart centres with experience in treating tricuspid valve disease.
The great importance of the Heart Team
In addition to the innovations in the diagnosis and treatment of heart valves, the guidelines also repeatedly focus on the great importance of the heart team. This consists of an interdisciplinary team, which means that doctors from the fields of cardiology, cardiac surgery, anesthesiology, intensive care and general medicine are involved in the treatment decision alongside the affected person. This approach promises the greatest treatment success for the patient.
Thanks to the updated guideline and the experience of all the members of the Heart Team, your doctors will be able to consult with each other and thus find the best treatment option for you - together with you.