Searches were extended to studies, reviews, and other evidence involving human subjects that were published in English and indexed in PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected databases relevant to this guideline. Key search words included but were not limit- ed to the following: valvular heart disease, aortic steno- sis, aortic regurgitation, bicuspid aortic valve, mitral ste- nosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonic stenosis, pulmonic regurgita- tion, prosthetic valves, anticoagulation therapy, infective endocarditis, cardiac surgery, transcatheter aortic valve replacement or implantation, and percutaneous mitra- clip. Additionally, the committee reviewed documents related to the subject matter previously published by the ACC and AHA. The references selected and published in this document are representative and not all-inclusive. 1.2. Organization of the Writing Committee The writing committee was composed of clinicians, which included cardiologists, interventionalists, sur- geons, anesthesiologists, and a patient representative. Members were required to disclose all RWI relevant to the data under consideration. 1.3. Document Review and Approval This document was reviewed by 2 official reviewers each nominated by the ACC and the AHA, as well as content reviewers nominated by the ACC and AHA. Reviewers RWI information was distributed to the writing commit- tee and is published in this document (Appendix 2). 1.4. Scope of the Guideline The focus of this guideline is the diagnosis and man- agement of adult patients with valvular heart disease (VHD). A full revision of the original 1998 VHD guide- line was made in 2006, and an update was made in Another full revision was made in 2014,2 with an update in 2017.3 There was an additional statement of clarification specifically for surgery for aortic dilation in patients with bicuspid aortic valves (BAV) in 2016.4 The present guideline will replace the 2014 guideline and 2017 focused update. 