2021 ESC/EACTS Valvular Heart Disease Guidelines: interview with Alec Vahanian

• With an expanded indication for TAVI in the real world how do the new guidelines define the role of TAVI?
• There have been discussions on early intervention for severe aortic stenosis from trials such as RECOVERY (SAVR) and the ongoing EARLY TAVI trials. Do the guidelines address early intervention? If so, who are those that would benefit most and how can they be identified?
• Is there a role for stress testing in severe aortic stenosis and if so, for whom would it be recommended?
• Do the guidelines address the issue of age and risk?

• Where do the guidelines find the role of transcatheter repair following the two large and yet inconsistent trials addressing severe mitral regurgitation, namely the COAPT and MITRA-FR studies?
• Do the guidelines distinguish between functional and structural mitral regurgitation?
• Do the guidelines address quality of life and a patient-centered decision in patients with the different transcatheter therapies (repair or replacement)?
• Do the guidelines address operator and center volume/experience?

The role of both surgery and transcatheter intervention for the tricuspid valve remains limited and highly dependent on the stage. How do the guidelines differ from the 2017 ones with respect to tricuspid regurgitation?

• pregnancy and valve disease
• combined and multiple valve disease
• prosthetic valve choice

Finally, is there any aspect of valvular heart disease that has not been addressed by the current 2021 guidelines?