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ACC/AHA vs ESC/EACT Guidelines on valvular heart disease: EJPC Guideline comparison review

Maciej Debski1,2, Vasiliki Tsampasian1,2, Joseph Zacharias3

  • 1Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.

European Journal of Preventive Cardiology
|January 12, 2026
PubMed

Insights

Comparing 2025 European and American guidelines for valvular heart disease reveals key differences in intervention timing and transcatheter therapies. These updates guide clinical decisions and future research priorities.

Area of Science:

  • Cardiology
  • Clinical Decision-Making
  • Medical Guidelines

Background:

  • Valvular heart disease management presents ongoing clinical challenges.
  • International guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) offer frameworks for treatment.
  • Recent updates in 2025 highlight evolving practices.

Purpose of the Study:

  • To compare the latest international guidelines for valvular heart disease management.
  • To identify consistencies and discrepancies between the ACC/AHA and ESC/EACTS guidelines.
  • To highlight areas for future research in valvular heart disease.

Main Methods:

  • Comparative analysis of the 2025 ACC/AHA and ESC/EACTS guidelines.
  • Review of new trial evidence incorporated into the European guidelines.
  • Identification of key divergences in recommendations.

Main Results:

  • Broad agreement exists on intervention principles, prosthesis selection, and the role of Heart Teams.
  • Significant differences noted in thresholds for earlier intervention in aortic stenosis and regurgitation.
  • Expanded recommendations for transcatheter edge-to-edge repair, mitral valve replacement, and tricuspid repair/transcatheter therapies are present.
  • Evolving strategies for coronary assessment in transcatheter aortic valve implantation and sex-specific considerations are highlighted.

Conclusions:

  • The 2025 ESC/EACTS guidelines incorporate substantial new trial evidence, leading to key divergences from ACC/AHA recommendations.
  • Discrepancies exist in intervention timing, transcatheter therapy indications, and specific procedural approaches.
  • Future research should address these discrepancies and evolving aspects of valvular heart disease management.

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