The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Structural interventions

Evolving paradigms in valvular heart disease: where should guidelines move?

EuroIntervention 2019;15:851-856. DOI: 10.4244/EIJ-D-19-00818

1. William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom; 2. Institute of Cardiology, Jagiellonian University, Krakow, Poland; 3. Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; 4. Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 5. Med. Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany

The field of valve intervention is rapidly changing. Clinical practice guidelines are based on evidence and practical clinical experience. The randomised trials considered for the guideline recommendations regarding indications for TAVI cover the high-risk and intermediate-risk subgroups of patients. With new evidence for low-risk patients, consideration has to be given to discussing TAVI as the default strategy in the majority of patients. This is a paradigm shift from the established practice. More than ever, the patient will be at the centre of the decision making. The Heart Team is essential for optimal patient pathways, as patient factors, longevity and durability considerations have to inform the discussion. Further developments discussed in this article revolve around evidence on secondary mitral regurgitation and mitral edge-to-edge repair.

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