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Guidelines on the management of valvular heart disease (version 2012)

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Authors/Task Force Members, Vahanian, Alec, Alfieri, Ottavio, Andreotti, Felicita, Antunes, Manuel J., Barón-Esquivias, Gonzalo, Baumgartner, Helmut, Borger, Michael Andrew +65 more·2012·European Heart Journal
DOI 10.1093/eurheartj/ehs109
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Abstract

The ESC/EACTS Guidelines represent the views of the ESC and the EACTS and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to take them fully into account when exercising their clinical judgement.The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient and, where appropriate and necessary, the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

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  • Aortic valve replacement is reasonable in symptomatic patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF of at least 50% if clinical, haemodynamic and anatomic evidence indicates severe obstruction is the most likely cause of symptoms.

    “It is also reasonable to perform AVR in symptomatic patients with paradoxical low-flow, a low-gradient and preserved LVEF (≥50%) (Class IIa indication) provided there is clinical, haemodynamic and anatomic evidence that the obstruction is severe and the most likely cause of symptoms3;4;168.”

    From Calcific aortic stenosis (2016) · cites this paper as [4]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Patients with severe aortic stenosis who are asymptomatic by history but have reduced LVEF below 50% or are undergoing another cardiac surgical procedure should have their valve replaced as a Class I indication.

    “Patients with severe AS who are asymptomatic by history but who have a reduced LVEF (<50%) (Table 1) or are undergoing another cardiac surgical procedure should have their valve replaced (Class I indication)”

    From Calcific aortic stenosis (2016) · cites this paper as [4]

    Section 5.4.1 (page unavailable) says early surgery is indicated for rare asymptomatic patients with severe AS whose depressed LV function is not due to other causes. The retrieved AS passage does not specify an LVEF threshold of <50%. Section 5.7 discusses concomitant valve replacement with CABG, but does not establish the claim that undergoing another cardiac procedure is, in general, a Class I indication. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Patients with severe aortic stenosis who have symptoms and/or LV systolic dysfunction with LVEF below 50% have a firm Class I indication for aortic valve replacement.

    “those with severe AS who present with symptoms and/or LV systolic dysfunction (defined as a LVEF of <50%) have a firm (Class I, Box 1) indication for AVR”

    From Calcific aortic stenosis (2016) · cites this paper as [4]

    Section 5.4.1 strongly recommends early valve replacement for symptomatic patients with severe aortic stenosis who are candidates for surgery. It also says surgery is indicated for asymptomatic patients with depressed LV function, but only when the dysfunction is not due to another cause; Figure 2 uses LVEF <50% in its management pathway. The claim omits those qualifications and therefore states the indication more broadly than the guideline does. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Aortic valve replacement is reasonable in asymptomatic patients at low surgical risk with very severe aortic stenosis, defined by peak aortic jet velocity above 5 m/s or 5.5 m/s depending on the guidelines.

    “and in those at low surgical risk with very severe AS (peak aortic jet velocity >5 m/sec or 5.5 m/s, depending on the guidelines,)”

    From Calcific aortic stenosis (2016) · cites this paper as [4]

    Section 5.4.1 says surgery should be considered for asymptomatic patients at low operative risk with very severe aortic stenosis, defined here by peak velocity >5.5 m/s. It also requires normal exercise performance, which the citing sentence omits. This paper does not give >5 m/s as its threshold; the sentence attributes that alternative to other guidelines. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Aortic valve replacement is reasonable as a Class IIa indication in asymptomatic patients with severe aortic stenosis and decreased exercise tolerance or a drop in blood pressure with exercise.

    “It also is reasonable to perform AVR (Class IIa indication) in asymptomatic patients with severe AS and decreased exercise tolerance or a drop in blood pressure with exercise”

    From Calcific aortic stenosis (2016) · cites this paper as [4]

    Section 5.4.1 recommends considering AVR for an asymptomatic patient with severe aortic stenosis whose blood pressure falls below baseline during exercise. It describes early surgery as indicated for an abnormal exercise test, particularly when symptoms develop, rather than assigning a single Class IIa recommendation to both decreased exercise tolerance and a blood-pressure drop. No page number is provided in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Authors
Authors/Task Force Members, Vahanian, A., Alfieri, O., Andreotti, F., Antunes, M. J., Barón-Esquivias, G., Baumgartner, H., Borger, M. A., Carrel, T. P., De Bonis, M., Evangelista, A., Falk, V., Iung, B., Lancellotti, P., Pierard, L., Price, S., Schäfers, H.-J., Schuler, G., Stepinska, J., Swedberg, K., Takkenberg, J., Von Oppell, U. O., Windecker, S., Zamorano, J. L., Zembala, M., ESC Committee for Practice Guidelines (CPG), Bax, J. J., Baumgartner, H., Ceconi, C., Dean, V., Deaton, C., Fagard, R., Funck-Brentano, C., Hasdai, D., Hoes, A., Kirchhof, P., Knuuti, J., Kolh, P., McDonagh, T., Moulin, C., Popescu, B. A., Reiner, Ž., Sechtem, U., Sirnes, P. A., Tendera, M., Torbicki, A., Vahanian, A., Windecker, S., Reviewers:, D., Popescu, B. A., Von Segesser, L., Badano, L. P., Bunc, M., Claeys, M. J., Drinkovic, N., Filippatos, G., Habib, G., Kappetein, A. P., Kassab, R., Lip, G. Y. H., Moat, N., Nickenig, G., Otto, C. M., Pepper, J., Piazza, N., Pieper, P. G., Rosenhek, R., Shuka, N., Schwammenthal, E., Schwitter, J., Mas, P. T., Trindade, P. T., & Walther, T.
Affiliations
  • Université Paris Diderot (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • IRCCS Ospedale San Raffaele (IT)
  • University of Liège (BE)
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2012-08-24
Volume
33
Issue
19
Pages
2451-2496
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehs109
OpenAlex
W1948348644
Cited by
3,559
References
0
Citations by year
2026: 10 · 2025: 34 · 2024: 57 · 2023: 76 · 2022: 70 · 2021: 114 · 2020: 118 · 2019: 194 · 2018: 278 · 2017: 603 · 2016: 572 · 2015: 531 · 2014: 497 · 2013: 346 · 2012: 32
FWCI
289.41
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • BORIS (University Library Bern) (acceptedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
  • Open Repository and Bibliography (University of Liège) (submittedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
Keywords
valvular heart disease, clinical management
MeSH terms
Arrhythmias, Cardiac, Cardiotonic Agents, Coronary Disease, Diagnostic Imaging, Cardiac Catheterization, Heart Valve Diseases, Heart Valve Prosthesis, Humans, Rheumatic Fever, Risk Assessment, Heart Valve Prosthesis Implantation, Endocarditis, Non-Infective, Balloon Valvuloplasty

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