2025 ESC/EACTS valvular heart disease guidelines: key updates and surgical implications for cardiac surgeons

The 2025 ESC/EACTS Guidelines for valvular heart disease introduce substantial changes in timing and modality of intervention, making a focused appraisal of their surgical implications highly relevant for contemporary cardiac practice.

The guidelines formalize imaging-based staging of cardiac damage, lower thresholds for intervention in aortic stenosis and primary mitral regurgitation, and refine age- and risk-stratified allocation of surgery vs. transcatheter therapies across aortic, mitral, and tricuspid disease. They expand indications for transcatheter aortic valve implantation, mitral and tricuspid transcatheter edge-to-edge repair, and transcatheter valve replacement in carefully selected high-risk patients, while strengthening the role of durable surgical valve repair, complex aortic and multivalve procedures, and lifetime valve management strategies. Organizationally, they define and emphasize the importance of Heart Valve Centres and volume-outcome relationships.

These guideline recommendations reflect upon contemporary evidence to support thoughtful decision making, encourage earlier intervention, and reinforce the central role of cardiac surgery and cardiology partnerships in achieving best patient outcomes through Heart Valve Centres. Cardiac surgeons should continue advance excellence in valve repair and reconstructive surgery and embrace the complementary role of transcatheter valve therapies.