2021 ESC/EACTS VHD Guidelines

A new treatment pathway for severe aortic stenosis (sAS) patients

Treatment and guidelines

  • All severe aortic stenosis (sAS) patients* should now be referred to the Heart Team for a treatment evaluation1
  • The guidelines recommend transfermoral transcatheter aortic valve implantation (TF-TAVI) as preferred standard of care (class IA recommendation) in patients ≥75 years of age**, as well as for additional patient groups <75 years of age1
  • The Heart Team recommendation should be discussed with the patient, who can then make an informed treatment decision between the option of TAVI or surgical aortic valve replacement (SAVR)1

Aortic Valve Replacement (AVR) treatment modality is now based on age and not surgical risk as first deciding factor1

The evidence supporting these changes originated from multiple real-world studies, registries and randomized controlled trials.1,2

Graphic showing decision criteria changes to the ESC/EACTS VHD Guidlines from 2017 to 2021 Graphic showing decision criteria changes to the ESC/EACTS VHD Guidlines from 2017 to 2021

How the evidence has modified the aortic stenosis (AS) treatment recommendations

Since the publication of the 2017 guidelines, new evidence has accumulated. This has led to a modification of both the AS treatment recommendations and the strength of those recommendations within the new 2021 publication.

Graphic showing changes to AS treatment recommendations and the strength of those recommendations from 2017 to 2021 Graphic showing changes to AS treatment recommendations and the strength of those recommendations from 2017 to 2021

A new standard of care for all patients with sAS* ≥75 years of age: TF-TAVI1

Graphic showing a new standard of care for all patients with severe aortic stenosis* ≥75 years of age: TF-TAVI

After patients have been referred on age — surgical risk, anatomical and procedural factors, comorbidities and frailty need to be assessed1

TAVI may be favourable in:

Graphic showing when TAVI may be favourable, and when surgery may be favourable Graphic showing when TAVI may be favourable, and when surgery may be favourable

Surgery may be favourable in:

Graphic showing when TAVI may be favourable, and when surgery may be favourable Graphic showing when TAVI may be favourable, and when surgery may be favourable

The guidelines recommend that all patients with sAS* are evaluated by the Heart Team and included in treatment decisions

The 2021 ESC/EACTS guidelines on AS treatment emphasise the need for patients to understand and decide on their preferred treatment.

A smiling female patient is shown talking to her doctor as she makes an informed treatment choice

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*With a treatment indication

**Based on evaluation of clinical, anatomical and procedural factors

aVia non-transfemoral approach

bFor example: high risk of coronary obstruction due to low coronary ostia or heavy leaflet/LVOT calcification

References:

1. Vahanian A, Beyersdorf F, Praz F, et al. Eur Heart J. 2021; ehab395. doi:10.1093/eurheartj/ehab395
2. Baumgartner H, Falk V, Bax JJ, et al. Eur Heart J. 2017; ehx391. doi:10.1093/eurheartj/ehx391

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