Interplay between medical and interventional therapies in valvular heart disease and heart failure: an expert opinion paper

Heart failure (HF) and valvular heart disease (VHD) often coexist and share complex pathophysiological pathways. Traditional management strategies follow a step-by-step approach, prioritizing guideline-directed medical therapy (GDMT) and reserving interventional (surgical or percutaneous) options only in case of persistent symptoms or worsening HF after GDMT. However, greater experience with the use of percutaneous procedures, even in high-risk patients, could support a more integrated approach, which exploits the synergistic effects of medical and interventional therapies to increase the tolerability of one vs the other, thereby improving quality of life and outcomes through their synergic effects. This expert opinion paper summarizes current data and evolving practices in the management of VHD in patients with HF, including secondary mitral regurgitation, aortic stenosis, aortic regurgitation, and tricuspid regurgitation.