Comments on the Summary of the ESC guidelines on the management of valvular heart disease (version 2012)
Abstract
The Euro Heart Survey on valvular heart disease discovered a large number of patients with severe symptomatic valve diseases, who were not indicated for intervention [1,2]. The reasons were mainly older age and left ventricular dysfunction.
The new ESC guidelines clearly specify the possibility of surgical or interventional treatment of high risk patients in experienced centers. On the other hand, we can see the trend toward early surgery in asymptomatic patients with severe valvular disease.
The operation before ventricular dilatation and dysfunction improves early mortality, as well as long-term postoperative survival. It was the development of echocardiography with detailed noninvasive evaluation of the valvular pathology and its consequences, which enabled the quick progress in valve-sparing surgery.
The absence of life-long anticoagulation and low surgical mortality in asymptomatic patients with good ventricular function facilitates the early indication for surgery.