LAUSR

This Focus Issue on valvular heart disease (VHD) contains the ‘2021 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)’ by Alec Vahanian and colleagues from the ESC/EACTS Scientific Document Group. Since the publication of the previous version of the guidelines on the management of VHD in 2017, new evidence has accumulated, particularly regarding nonpharmacological interventions. For the choice of the mode of intervention, current evidence reinforces the critical role of the Heart Team, which should integrate clinical, anatomical, and procedural characteristics beyond conventional scores, and informed patient’s treatment choice. Regarding surgery, increasing experience and procedural safety has led to expansion of indications toward earlier intervention in asymptomatic patients with aortic stenosis, aortic regurgitation, or mitral regurgitation (MR), and now stress the preference for valve repair when it is expected to be durable. A particular emphasis is put on the need for more comprehensive evaluation and earlier surgery in tricuspid regurgitation (TR). Concerning transcatheter aortic valve implantation (TAVI), new information from randomized studies comparing TAVI vs. surgery in low-risk patients with a follow-up of 2 years has led to a need to clarify which types of patients should be considered for each mode of intervention. Transcatheter edge-to-edge repair (TEER) is increasingly used in severe MR and has been evaluated against optimal medical therapy, resulting in an upgrade of the recommendation. The larger number of studies on transcatheter valve-in-valve implantation after failure of surgical bioprostheses served as a basis to upgrade its indication. Finally, the encouraging preliminary experience with transcatheter tricuspid valve interventions (TTVIs) suggests a potential role for this treatment in inoperable patients, although this needs to be confirmed by further evaluation. In ‘The year in cardiovascular medicine 2021: valvular heart disease’, Helmut Baumgartner from the University Hospital Muenster in Germany, and colleagues point out that the increasing burden of VHD—in particular in an ageing population —is recognized by medical experts, although there is less awareness of these conditions by the general public and relevant stakeholders. Together with emerging non-surgical interventional treatment options, this has led to intense research interest in VHD, with an enormous number of publications during the last year. Many of these publications address interventional treatment, including technical refinements and outcomes compared with surgery or medical therapy. In addition, attention has focused on pathophysiological aspects, improved diagnosis, risk stratification, and optimal timing for intervention. Importantly, new Guidelines for the management of VHD have been published by both the ESC/EACTS and ACC/AHA. This contribution can neither address all changes in the guidelines nor acknowledge all appreciable research efforts over this year. The authors have therefore selected a few papers as examples that reflect the breadth of ongoing research, with the expectation that interested readers will find additional articles using online searches. Severe MR following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. Most of these patients are deemed as high risk for mitral valve surgery or even considered inoperable, and thus are managed conservatively with a grim prognosis. Until recently, the only possible intervention targeting MR was