At a glance, it looks like he has less damage, less healing, and higher cool downs across the board. Are we supposed to build him tanky now? Or is the new tides of blood going to do that much more damage?
GhostOfTsushima2 votesHe was tanky to begin with LOL
Chaos Milk Tea1 votesThat just kind of happened though. His only tank item before was spirit visage.
WoonStruck1 votesThat just kind of happened though. His only tank item before was spirit visage.
Actually, best build before was 
in the large majority of cases. Deathcap can be swapped in if any of those are unnecessary in your current game.
Spirit Visage was actually a bad buy on him before unless going against excessive magic damage. 30% CDR rune page w/ swifties+Stormraider's Surge is the way to go pre-rework.
Post rework:
will be core. Rylai's is practically necessary to function still, while Deathcap pushes his Q, both healing and damage, farther than any other single item. This is important because AP is horribly slot-inefficient on him now, but you still need some AP. His ratios were gutted with this update. Spirit Visage provides the function of both a defensive/offensive/sustain buy now. Its too good not to get.
will be the situational items. Both of the armor/hp options provide better maneuverability in fights, so long as you don't auto attack late game with DMP. Warmog's allows you to push without killing yourself, as well as do a better job at staying healthy as a front-liner (which he is much more of now); also 10% CDR now. Do note that HP has better damage scaling on him now than AP. Again, AP is horribly inefficient to dedicate yourself towards now.
will be extremely situational buys. They are not efficient purchases on him now, but do have situations that they perform very strongly in.
Note that Zhonya's is no longer core. The AP dropping significantly, not offering HP that he needs now, and the active not meshing with his new kit's pattern all work against it. Plus significantly longer CD on the active.
Void is no longer core either, due to AP being so inefficient on him now. If enemies are buying MR, yes, it becomes a very good damage item. However, often times, the survivability+damage via a tank item will do more for you. It won't be a 3rd slot damage item anymore. Pretty much only going to be used when everyone is stacking MR.
A 10-30% CDR rune page will be used on him. Likely 20% most of the time, but I'd rather stick with Swifties, Mercs, Tabi, Sorc, etc so 30% for me. Swifties+Stormraider's Surge OP.
IronwallJackson1 votesHis Q should actually do better damage over the course of his 3 casts and E is fairly decent. The new passive effect on Transfusion basically doubles the power and healing every 3rd use, so over time, your damage output and healing will be more than acceptable. His R, on the other hand, has taken hit damage-wise to give the potential for a substantial heal when it pops, and also to move power elsewhere in his kit.
Note: The %missing health healing is outstanding when you're low health, but with the removal of e-stack healing buffs, your sustain isn't super great, which forces you to really pick your moments to trade.
Chaos Milk Tea1 votesCURRENT: 230 x 3 = 690 base damage, 60% x 3 = 180% ap ratio NEW: 160 x 2 =320, plus the doubled damage is 640 base damage. 45% x 2 = 90%, plus the doubled damage is 180% ap ratio
The max cool down is now 5 instead of four, and you will never get the cool down low enough to cast two transfusions during the haste (they probably intended this by changing the cool down). Even if you play correctly and use transfusion every time you activate the haste, it can only do less damage over time. If you don't get every empowered Q, it's even less.