Valvular Heart Disease: Evidence-Based Practice Update (NEJM 2026) Valvular_Heart_Disease.pdf<\/p>\n
Source: NEJM Group. Valvular Heart Disease: Evidence-Based Practice Update. Received via NEJM email on 14 July 2026.<\/p>\n
Tricuspid Regurgitation (TR):<\/p>\n
* TR is no longer considered the \u201cforgotten valve\u201d; severe TR is independently associated with increased mortality.
\n* Early diagnosis is essential, as symptoms are often mistaken for normal aging or right heart failure.
\n* Secondary TR accounts for ~80% of cases, while primary TR represents only 5\u201310%. Valvular_Heart_Disease.pdf
\n* Secondary TR is classified into:
\n* Atrial TR: annular\/right atrial dilation (often AF, HFpEF).
\n* Ventricular TR: RV remodeling from pulmonary hypertension or RV disease.
\n* CIED-related TR: pacemaker\/ICD lead interference.
\n* Echocardiography remains the first-line imaging modality; cardiac MRI and CT are increasingly important for quantification and transcatheter planning.
\n* For patients considered for transcatheter intervention, advanced TR is graded as severe (3+), massive (4+), or torrential (5+) to better define disease severity and assess treatment outcomes.
\n* Medical therapy focuses on diuretics and treatment of the underlying cause; rhythm control for AF may reduce TR severity.
\n* Surgery is recommended when severe TR accompanies left-sided valve surgery; transcatheter therapies are expanding for high-risk patients.<\/p>\n
Secondary Mitral Regurgitation:<\/p>\n
* Optimize guideline-directed medical therapy (GDMT) before intervention.
\n* Heart Team evaluation is essential.
\n* TEER is recommended for selected symptomatic patients despite optimal medical therapy.
\n* The landmark COAPT trial enrolled patients with LVEF 20\u201350%. Patient selection for TEER should always be individualized by a multidisciplinary Heart Team.<\/p>\n
Asymptomatic Severe Aortic Stenosis<\/p>\n
* Two management strategies have been evaluated: early intervention (TAVR or SAVR) versus clinical surveillance.
\n* EARLY-TAVR (2025): Early TAVR reduced the composite of death, stroke, or unplanned cardiovascular hospitalization compared with clinical surveillance.
\n* AVATAR 10-year follow-up (2026): Early surgical AVR improved long-term outcomes compared with conservative management.
\n*The decision to intervene, and the choice of TAVR or SAVR, should remain individualized by the Heart Team, considering age, surgical risk, life expectancy, valve anatomy, comorbidities, and patient preferences.<\/p>\n
TAVR vs SAVR<\/p>\n
* Seven-year follow-up (2025): Both TAVR and SAVR demonstrated durable long-term outcomes.
\n* Treatment choice should be individualized based on:
\n* Age and life expectancy.
\n* Surgical risk.
\n* Valve anatomy.
\n* Need for concomitant cardiac surgery.
\n* Patient preferences.<\/p>\n
Practical Messages<\/p>\n
* Earlier recognition and referral improve outcomes across valvular diseases.
\n* Multimodality imaging is increasingly central to diagnosis and procedural planning.
\n* Management should be individualized through a multidisciplinary Heart Team.
\n* Transcatheter valve therapies continue to expand beyond aortic stenosis into mitral and tricuspid disease.<\/p>\n