ESC/EACTS 2025 Guidelines — Valvular Heart Disease

The 2025 ESC/EACTS guideline moves the intervention thresholds again, and it does so in both directions depending on the lesion. Asymptomatic severe disease with objective evidence of consequence is treated earlier than it once was; the transcatheter options have expanded, and the choice between them is now a structured Heart Team decision rather than a single cut-off.

Expect questions on the aortic valve: who gets TAVI and who gets surgery, how age, anatomy, access and life expectancy enter the decision, and what to do when the transfemoral route is closed. On the mitral and tricuspid side, the distinction between primary and secondary regurgitation governs almost everything that follows.

The antithrombotic recommendations after intervention are a separate cluster and are examined heavily, usually in the negative: no dual antiplatelet therapy after TAVI without an independent indication, no routine anticoagulation for subclinical leaflet thrombosis, and no direct oral anticoagulant in rheumatic mitral stenosis.