[Heart Valve Disease - update ESC guideline 2017]

Surgical management of patients with aortic valve stenosis is declining and Transcatheter aortic valve implantation (TAVI) is becoming the treatment of choice in many patients. The ESC guideline integrated results of randomized controlled trials in patients with intermediate surgical risk for the first time. TAVI showed good and comparable results to the standard surgical approach.Mitral regurgitation (MR) is a complex disease with good surgical results in primary MR and mixed results in secondary MR. Secondary MR is mainly based on left ventricular disease with subsequent dilatation. Interventional treatment with edge-to-edge-repair (Mitraclip) is an alternative therapeutic approach in patients with high surgical risk.The recommendation on treatment of concomitant coronary artery disease in patients with valvular heart disease was updated based on recent scientific results. Proximal coronary artery stenosis ≥ 70 % should be treated by percutaneous coronary intervention before TAVI or alternatively simultaneous surgical bypass grafting during valve surgery should be performed.Due to increasing interventional and surgical therapeutic options for the treatment of all four heart valves, the Heart Team is of upmost importance. The cardiologist and the cardiac surgeon should analyse all diagnostic and therapeutic results and see the patient. Colleagues of other specialities should join the team if necessary. There are several recommended requirements for heart valve centres defined in the guideline. The primary goal is excellent and individualized patient care.