New European guidelines published today at the ESC Congress 2025 aim to standardize the diagnosis and treatment of valvular heart disease (VHD) across the continent, ensuring patients benefit more consistently from the latest advances in less invasive therapies.
The 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease were developed by an international panel of cardiology and cardiac surgery experts, co-chaired by Professor Fabien Praz, interventional cardiologist at Bern University Hospital, and Professor Michael Borger, Director of Cardiac Surgery at the University of Leipzig, Germany.
Expanding use of minimally invasive options
The updated recommendations emphasize when to employ less invasive procedures—such as transcatheter aortic valve implantation (TAVI) or minimally invasive mitral valve surgery—based on evidence from large randomized controlled trials.
Professor Borger highlighted the uneven care currently delivered across Europe.
“We see major differences in clinical practice, from regions where treatments exceed guideline recommendations to areas where patients miss out on even basic therapies,” he said. “These guidelines are designed to bring consistency and ensure patients receive evidence-based care regardless of geography.”
Focus on equity and patient-centered care
Professor Praz noted that undertreatment, particularly among older patients, remains a significant issue.
“Our goal is to make treatment timely and equitable, ensuring that complex cases are managed by multidisciplinary Heart Teams in specialized, high-volume centers,” he explained. “The focus is on the patient—their needs, their outcomes, and fairness in access.”
Disease burden and context
VHD occurs when one or more of the heart’s valves fail to function properly, causing symptoms such as breathlessness, fatigue, dizziness, swollen limbs, or chest pain. Some patients remain asymptomatic.
Aortic stenosis is the most frequently treated form in developed countries, affecting an estimated nine million people worldwide. Mitral regurgitation, the most prevalent overall, impacts about 24 million people globally. Prevalence rises sharply with age, often in patients with multiple coexisting health conditions.
Key updates in the 2025 guidelines include:
Expanded recommendations for sex-specific treatment considerations
Stronger emphasis on identifying underlying causes and mechanisms of valve disease
Structured guidance for diagnosing and managing multiple or combined valve disorders
Recognition of advanced imaging—such as 3D echocardiography, cardiac CT, and cardiac MRI—as central to evaluation and planning
Building on prior guidance
The 2025 update builds on the 2021 ESC/EACTS guidelines, integrating rapidly expanding clinical evidence and expert consensus to provide clearer, more practical recommendations for daily clinical decision-making.
“Following these guidelines will give clinicians across Europe and beyond confidence that patients are receiving the best available care,” said Borger.
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