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2021 ESC/EACTS Guidelines Summary & Key considerations1 

The ESC/EACTS guidelines were updated and launched at ESC Congress 2021. The last update occurred in 2017.

Based on previously published scientific evidence, these new guidelines reflect contemporary clinical practice and provide heart teams directions on the management of aortic valve stenosis patients.


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"...intervention should be carefully considered by the Heart Team for all patients, accounting for individual age and estimated life expectancy, comorbidities, anatomical and procedural characteristics..."

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"Symptomatic severe aortic stenosis has dismal prognosis and early intervention is strongly recommended in all patients."
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"The Heart Team recommendation should be discussed with the patient who can then make an informed treatment choice."

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"The main purpose of Heart Valve Centres as centres of excellence in the treatment of VHD is to deliver optimal quality of care with a patient-centred approach."

Watch Prof. Zamorano's
key takeaways from the
2021 ESC/EACTS Guidelines on
aortic stenosis

Video of Dr Zamorano's takeways of ESC guidelines
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These new guidelines include important guidance on treating younger and low surgical risk patients regarding the treatment choice of TAVI or SAVR, reinforcing the importance of the heart team. 

Indications for Intervention1


Choice of Intervention1

infographic esc eacts

Medtronic treatment options for TAVI & SAVR

Medtronic has studied over 20’000 severe aortic stenosis patients. As a result these pivotal trials contributed to the evolution of the clinical guidelines today.

Thanks to that, you can offer to more patients the less invasive TAVI treatment.

The updated indications for treatment will allow Heart teams more freedom to choose the best aortic valve replacement. SAVR and TAVI are excellent treatment options for aortic stenosis.

Medtronic offers the full spectrum to treat aortic stenosis patients with our products Evolut™ TAVI and Avalus™ Bioprosthesis

Meet the Evolut™ Pro+ TAVI System

From a design built on a proven platform2, the EVOLUT™ PRO+ system provides the performance and outcomes you need to help patients live life to the fullest. 

The Evolut™ TAVI's supra-annular, self-expanding valve design delivers exceptional hemodynamics and it is the only TAVI device to demostrate hemodynamic superiority in a low-risk clinical trial vs SAVR3.









Avalus™ Bioprosthesis is the Next Generation stented pericardial aortic valve, developed by Medtronic to advance cardiac surgical care. A powerful synergy of experience and innovations for better performance, improved implant experience and life-time patient management. 

The PERIGON Pivotal Trial4 - the largest prospective, interventional, non-randomized, worldwide, multi-site trial for the latest generation pericardial stented valves demonstrated safety and effectiveness of Avalus™:

  • 100% Freedom from SVD through 4 years,4
  • Substantial improvements of hemodynamics after implantation are maintained over time,4
  • >72% of patients continue to report NYHA Class I over 4-5 years.4
Surgical valves Avalus Bioprosthesis

AVALUS™ Bioprosthesis

0 SVD through 5 years Confirmed by the PERIGON clinical trial.

AOA™ Tissue Treatment for Long-Term Durability

AOA™ Tissue Treatment for Long-Term Durability

To mitigate the calcification with 20+ years of use in Medtronic tissue valves portfolio.
Stable and Predictable Implantation

Stable and Predictable Implantation

Watch the real case implantation experience of Avalus™ Bioprosthesis by Prof. Michael G. Moront.

Meet your patients’ need for minimally invasive procedures: choose Avalus™ Bioprosthesis and COR-KNOT® for SMART AVR.

5 features of Avalus™ Bioprosthesis and COR-KNOT® to advance your MICS program:

  • Straightforward and fast procedure
  • Minimally invasive access
  • Avoid compromises of sutureless valves 
  • Reliable design with internally mounted leaflets
  • TAV-in-SAV ready
Avalus Cor-Knot® fasteners image

Avalus™ Bioprosthesis and Cor-Knot® Fasteners

HOSPITAL management Key considerations

Alongside the clinical recommendations, the 2021 ESC/EACTS guidelines1 also define key requirements for Heart Teams and Heart Valve Centres, covering aspects of hospital management including:

  • Informed Patient Choice 
  • Timely Patient Referral 
  • Optimised Patient Management 
  • Dedicated Nursing Personnel 
  • Stewardship of Economic Resources
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Are you ready to be a Heart Valve Centre of excellence?

Optimise your TAVI Pathway

With Heart Team decisions evolving towards clinical, anatomical, and procedural characteristics beyond conventional scores, and informed patient’s treatment choice.

WATCH THESE VIDEOS to hear how TAVI experts across Europe are focusing to optimise their TAVI pathways to treat more patients at lower cost and without compromising patient outcomes:

Remote patient management

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As new guidelines are paving the way for expanded treatment options, more and more patients as well ask for contemporary support on their care pathway besides the actual procedure. Therefore, Heart Teams are looking for new ways to prepare and manage their aortic valve patients in a holistic, yet efficient way.

Get Ready® for the remote management of patients with aortic valve stenosis aims to optimize the entire care pathway. It uses an extensive knowledge library of questionnaires and protocols based on Key opinion leaders input and literature guidelines.

Get Ready® helps you manage your patients and monitor their risk while they are waiting for their intervention. In addition, once scheduled, you can remotely manage their preparation and follow-up. 

Learn More



Alec Vahanian, Friedhelm Beyersdorf, Fabien Praz, Milan Milojevic, Stephan Baldus, Johann Bauersachs, Davide Capodanno, Lenard Conradi, Michele De Bonis, Ruggero De Paulis, Victoria Delgado, Nick Freemantle, Martine Gilard, Kristina H Haugaa, Anders Jeppsson, Peter Jüni, Luc Pierard, Bernard D Prendergast, J Rafael Sádaba, Christophe Tribouilloy, Wojtek Wojakowski, ESC/EACTS Scientific Document Group, 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Heart Journal, 2021;, ehab395,


Data on file (>20 randomized controlled trials with over 20.000 patients enrolled)


Popma JJ. Deeb GM, Yakubov SJ, et al. Transcatheter Aortic-Valve Replacement with a Self-expanding valve in Low-risk patients. N Engl J Med. May 2, 2019:380(18):1706-1715


PERIGON Pivotal Trial data on file as of January 2021

See the CoreValve™ Evolut™ R, the CoreValve™ Evolut™ PRO and the Evolut™ PRO+ device manual(s) for detailed information regarding the instructions for use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events. 

For further information, contact your local Medtronic representative and/or consult the Medtronic website at For applicable products, consult instructions for use on Manuals can be viewed using a current version of any major internet browser. For best results, use Adobe Acrobat® Reader with the browser.

The commercial name of the Evolut™ R device is Medtronic CoreValve™ Evolut™ R System, the commercial name of the Evolut™ PRO device is Medtronic CoreValve™ Evolut™ PRO System, and the commercial name of the Evolut™ PRO+ device is Medtronic Evolut™ PRO+ System.

COR-KNOT® is a registered trademark of LSI Solutions, Inc.

The information on this web page is intended for educational purposes based on an identified need, it is not meant as a substitute for the Instructions for Use or product training, nor to constitute medical advice or in any way replace the ESC/EACTS guidelines or the independent medical judgment of a trained and licensed physician with respect to any patient needs or circumstances. Please refer to full ESC/EACTS guidelines for detailed explanation of patient populations.

The physician is solely responsible for all decisions and medical judgments relating to the treatment of their patients.