What is heart valve disease?

Heart valve disease encompasses any malfunction of the heart's four valves — aortic, mitral, tricuspid and pulmonary. Valves can be stenotic (narrowed — obstructing blood flow) or regurgitant/insufficient (leaking — allowing backflow). The most clinically important are: aortic stenosis (AS) — the most common severe valve disease in elderly adults in HICs; mitral regurgitation (MR) — the most common valve disease globally; and rheumatic heart disease (RHD) — valve damage from streptococcal infection, predominantly in LMICs.

What causes aortic stenosis?

In adults in high-income countries, calcific degenerative AS is most common — the calcium build-up on the valve leaflets over decades, similar to atherosclerosis. Risk factors: older age, male sex, smoking, hyperlipidaemia, hypertension, chronic kidney disease, and a bicuspid aortic valve (congenital — present in 1-2% of population, causes earlier AS). In LMICs: rheumatic AS from rheumatic fever is more common. There is no pharmacological treatment to prevent or slow AS progression — only valve replacement treats severe symptomatic AS.

What is TAVI and how has it transformed AS treatment?

TAVI (transcatheter aortic valve implantation) — placing a bioprosthetic valve inside the diseased native valve via catheter (most commonly through the femoral artery) without open heart surgery — was initially developed for patients too high-risk or inoperable for surgery. Pivotal trials have progressively extended indications: PARTNER 1 (inoperable, 2010); PARTNER 1B (high-risk); PARTNER 2 (intermediate-risk); PARTNER 3 and EVOLUT Low Risk (2019 — low-risk patients, showing TAVI non-inferior to surgery). TAVI is now the dominant approach for AS in most age groups, with surgery reserved for younger patients (where long-term durability of the transcatheter valve is uncertain) and certain anatomical situations.

What is rheumatic heart disease and how is it prevented?

Rheumatic heart disease (RHD) results from repeated episodes of rheumatic fever — an autoimmune response to group A streptococcal (GAS) throat infections, damaging the heart valves over time. Primary prevention: treating streptococcal throat infections with penicillin. Secondary prophylaxis: monthly benzathine penicillin G injections (1.2g IM, every 3-4 weeks) in people who have had rheumatic fever — preventing further GAS infections and recurrent carditis. WHO recommends secondary prophylaxis for 10 years after the last episode of rheumatic fever (or until age 25, whichever is longer). RHD affects 39 million people and kills 300,000/year — entirely preventable.

What is infective endocarditis?

Infective endocarditis (IE) is a microbial infection of the heart valve surfaces — typically by bacteria (Staphylococcus aureus most common — from skin, IV lines; viridans streptococci — from oral flora; enterococci) or rarely fungi. Vegetations (bacterial clumps) form on the valve, causing valve destruction, systemic emboli (stroke, renal infarction) and sepsis. Mortality remains approximately 20-30% despite modern treatment. Treatment: prolonged IV antibiotics (4-6 weeks); surgery in approximately 50% (for severe valve dysfunction, embolic events, persistent infection).

When should valve surgery or TAVI be done?

ESC and ACC/AHA guidelines recommend intervention for: severe symptomatic AS (TAVI or surgery — Class I); severe asymptomatic AS with certain criteria (reduced LVEF, very high gradient, rapidly progressing — Class IIa); severe symptomatic MR (surgery preferred — repair over replacement; or MitraClip in high-risk surgical candidates). The key principle: waiting until symptoms develop increases surgical risk and reduces benefit. Watchful waiting with regular echocardiography for asymptomatic severe valve disease is standard.

How does GMJ News cover valve disease?

GMJ News covers WHO/ESC valve disease burden data, TAVI trial results and access, rheumatic heart disease prevention in LMICs, MitraClip evidence, endocarditis management and the streptococcal-RHD prevention story. RHD is a preventable tragedy in many LMIC settings — directly relevant to PHIG's cardiovascular quality programme and Georgian hospital accreditation standards.

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Heart Valve Disease

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Heart valve disease — encompassing aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation and right-sided valvular pathology — affects approximately 100 million people globally, causing progressive heart failure, arrhythmia and premature death, with two dominant aetiologies: degenerative calcific disease (predominant in high-income countries) and rheumatic heart disease (RHD — affecting approximately 39 million people and causing 300,000 deaths/year in LMICs) (WHO). The transcatheter aortic valve implantation (TAVI) revolution — extending to low-surgical-risk patients after PARTNER 3 and EVOLUT Low Risk trials — has transformed the management of severe aortic stenosis.

Key messages

100 million people — two distinct aetiologies

Heart valve disease affects approximately 100 million people globally. Two dominant forms: degenerative calcific valve disease (primarily aortic stenosis — HICs, elderly populations) and rheumatic heart disease (RHD — approximately 39 million people, predominantly in LMICs, preventable with benzathine penicillin) (WHO).

TAVI extends to low-risk patients

Transcatheter aortic valve implantation (TAVI) — placing a new valve via catheter without open heart surgery — has been extended to low surgical risk patients after the PARTNER 3 and EVOLUT Low Risk trials (2019), potentially replacing surgical valve replacement for aortic stenosis in a majority of patients.

Rheumatic heart disease — 300,000 deaths/year

Rheumatic heart disease — the most common acquired heart disease in young people in LMICs — kills approximately 300,000 people per year and disables millions more. It is entirely preventable by treating streptococcal throat infections with benzathine penicillin and prevented by secondary prophylaxis.

Mitral valve transcatheter therapy

MitraClip (transcatheter edge-to-edge mitral valve repair) is approved for symptomatic severe mitral regurgitation in surgical high-risk patients — with expanding indications and emerging data.

Infective endocarditis complicates valve disease

People with structural heart valve disease are at elevated risk of infective endocarditis (IE) — a life-threatening infection of the valve surface. Antibiotic prophylaxis before dental procedures is recommended for the highest-risk patients (prosthetic valves, previous IE, congenital heart disease).

Anticoagulation for atrial fibrillation and mechanical valves

Mechanical prosthetic valves require lifelong antibiotic prophylaxis for IE and anticoagulation with warfarin (DOACs are NOT recommended for mechanical valves). Tissue valves do not require anticoagulation unless AF is present.

Key statistics

~100M

people with heart valve disease globally

WHO

39M

people with rheumatic heart disease

GBD 2019

300K

RHD deaths/year (predominantly LMICs)

WHO/GBD

5-10%

of adults over 65 with significant valve disease

ESC

PARTNER 3

trial confirming TAVI non-inferiority vs surgery in low-risk

ESC/NEJM 2019

1.2g

benzathine penicillin G every 3-4 weeks prevents RHD progression

WHO

Heart valve disease global burden — cases by aetiology (millions) — WHO/GBD

Source: WHO/GBD. Degenerative dominates HICs; rheumatic dominates LMICs.

Glossary of key terms

Aortic stenosis (AS)
ESC/AHANarrowing of the aortic valve orifice — the most common severe valve disease in adults over 65 in HICs. Predominantly degenerative calcific. Classic triad: angina, exertional syncope, heart failure (dyspnoea). Once symptomatic: median survival 2-3 years without valve replacement. Treated with surgical AVR or TAVI.

TAVI (Transcatheter Aortic Valve Implantation)
ESC/AHA/FDAPercutaneous replacement of the aortic valve — inserting a bioprosthetic valve via femoral artery catheter (transfemoral approach) or alternative access, without open heart surgery. Originally for inoperable/high-risk patients; extended to intermediate- and now low-risk patients after PARTNER 3 and EVOLUT Low Risk trials.

Rheumatic heart disease (RHD)
WHOValve damage (predominantly mitral and aortic) from repeated episodes of rheumatic fever — an autoimmune reaction to group A streptococcal pharyngitis. Mitral stenosis is the classic RHD lesion. The most common acquired heart disease in young people in LMICs. Preventable by treating streptococcal throat infections and secondary prophylaxis.

Mitral regurgitation (MR)
ESC/AHABackflow of blood into the left atrium during systole from a leaking mitral valve — caused by degenerative (prolapse) disease, ischaemic disease, cardiomyopathy, or rheumatic disease. The most common valve disease globally. Severe symptomatic MR: surgical repair (preferred) or replacement; or MitraClip in high-surgical-risk patients.

MitraClip
FDA/ESCA transcatheter edge-to-edge mitral valve repair device — delivered via femoral vein and transseptal puncture. Approved for symptomatic severe degenerative MR in surgical high-risk patients (EVEREST II trial); and for functional (secondary) MR in heart failure with reduced EF (COAPT trial — reduced HF hospitalisations).

Infective endocarditis (IE)
ESCMicrobial infection of the endocardial surface of the heart — predominantly valves. Most common pathogens: Staphylococcus aureus (most lethal — IV drug use, prosthetic valves); viridans streptococci (dental origin); enterococci. In-hospital mortality 20-30%. Treatment: 4-6 weeks IV antibiotics; surgery in approximately 50%. IE prophylaxis for dental procedures: amoxicillin for highest-risk patients (prosthetic valves, previous IE, cyanotic CHD).