The Year in Cardiology 2012: valvular heart disease.

Growth of the ageing population, advances in imaging techniques, newly available percutaneous interventions, and emphasis on the central role of the Heart Team in risk assessment and treatment selection combine to place valvular heart disease (VHD) at the centre of developments in cardiovascular medicine and surgery. However, VHD is poorly researched in comparison with other areas of cardiac disease, both at a basic scientific and clinical level. Until recently, there have been virtually no randomized controlled trials and international guidelines are largely based on expert consensus. Principal limitations to quality research are the diverse nature of patients with VHD, inability to identify individuals at the earliest stages of disease, and a lack of financial support and an appropriate investigational infrastructure. Guidelines attempt to address this evidence gap and a key publication this year was the joint European Society of Cardiology (ESC) and European Association of Cardiothoracic Surgeons (EACTS) Guidelines on the Management of VHD. This concise and practical document provides recommendations on patient evaluation and risk stratification for both surgical and interventional procedures, coupled with emphasis on multimodality imaging and recommendations from the European Association of Echocardiography on the quantification of valve lesions. Evidence-based implementation of surgical mitral valve repair and transcatheter aortic valve implantation (TAVI) feature strongly together with emphasis on the function of the multidisciplinary Heart Team in achieving optimal outcomes for this challenging group of patients.