ACC/AHA vs. ESC/EACTS guidelines on valvular heart disease: EJPC guideline comparison review

Abstract Abstract Valvular heart disease poses persistent challenges for clinical decision-making, and international guidelines provide essential frameworks for its management. The American College of Cardiology/American Heart Association last issued a full update in 2020 and an expert consensus on tricuspid regurgitation in 2025. The European Society of Cardiology/European Association for Cardio-Thoracic Surgery released their updated guidelines in 2025. Although there is broad alignment in principles of intervention, prosthesis choice, and the role of Heart Teams, the European document incorporates substantial new trial evidence. Key areas of divergence include thresholds for earlier intervention in aortic stenosis and regurgitation, expanded recommendations for transcatheter edge-to-edge repair and mitral replacement, formal integration of tricuspid repair and transcatheter therapies, evolving strategies for coronary assessment in transcatheter aortic valve implantation, and sex-specific considerations. This review highlights consistencies, discrepancies, and priorities for future research. Lay summary This review explains the main similarities and differences between the American and European guidelines on how to diagnose and treat heart valve disease.Both guidelines agree on most major principles but differ in areas such as timing of intervention, imaging requirements, and approaches to aortic stenosis, mitral regurgitation, tricuspid regurgitation, and coronary assessment before valve procedures.The European 2025 guidelines include newer evidence and often recommend earlier treatment or wider use of less invasive transcatheter procedures compared with the American 2020 guidance.