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Global Expert Views on Aortic Valve Repair and Replacement
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Global Expert Views on Aortic Valve Repair and Replacement

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 4867

Special Issue Editor

Dr. Jose Alberto De Agustín

E-Mail Website
Guest Editor
Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, 28040 Madrid, Spain
Interests: advanced imaging tests linked to interventions for structural heart disease

Special Issue Information

Dear Colleagues,

The treatment of aortic valve pathologies has undergone important changes in recent years. Open cardiac surgery has been giving way to less aggressive techniques, including transcatheter or surgeries with a minimally invasive approach and with the intention of preserving the aortic valve in cases of valve regurgitation. These new techniques have managed to improve the clinical results of patients and reduce the risk of complications. All of these modern techniques require prior in-depth research that includes several imaging techniques, such as transesophageal echocardiography, multidetector cardiac tomography or cardiac magnetic resonance. The intention of this Special Issue is to showcase state-of-the-art techniques for aortic valve repair and replacement as well as the imaging techniques required for the correct planning of these procedures.

Dr. Jose Alberto De Agustín
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic valve pathologies
  • minimally invasive approach
  • aortic valve repair
  • aortic valve replacement
  • imaging techniques

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Published Papers (4 papers)

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Research

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10 pages, 3217 KiB  
Article
Prognostic Relevance of Gradient and Flow Status in Severe Aortic Stenosis
by Eduardo Pozo Osinalde, Juan Ramón Bravo Domínguez, Lina De Lara Fuentes, Pedro Marcos-Alberca, José Juan Gómez de Diego, Carmen Olmos Blanco, Patricia Mahia Casado, María Luaces Mendez, Luis Collado Yurrita, Manuel Carnero-Alcázar, Pilar Jiménez-Quevedo, Luis Nombela-Franco and Julián Pérez-Villacastín
J. Clin. Med. 2024, 13(20), 6113; https://doi.org/10.3390/jcm13206113 - 14 Oct 2024
Viewed by 709
Abstract
Background: Severe aortic stenosis (AS) may present with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has a specific clinical profile, but its prognosis and management remain controversial. Our aim is to evaluate the [...] Read more.
Background: Severe aortic stenosis (AS) may present with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has a specific clinical profile, but its prognosis and management remain controversial. Our aim is to evaluate the impact of different AS patterns in the incidence of major clinical events. Methods: A retrospective observational study was carried out on all the consecutive patients diagnosed with severe AS at our tertiary hospital centre in 2021. Echocardiographic measurements were carefully reviewed, and patients were classified following current guidelines into four categories: high gradient (HG), concordant low-flow low-gradient (CLF-LG), paradoxical low-flow low-gradient (PLF-LG) and normal-flow low-gradient (NF-LG). The baseline characteristics and clinical events (heart failure admission, intervention and death) at 1-year follow-up were collected from medical records. The association between categories and events was established using Student’s t test or ANOVA as required. Results: 205 patients with severe AS were included in the study (81 ± 10 years old, 52.7% female). Category distribution was as follows: HG (138, 67.3%), PLF-LG (34, 19.8%), CLF-LG (21, 10.2%) and NF-LG (12, 5.9%). During the follow-up, 24.8% were admitted due to heart failure, 68.3% received valve replacement (51.7% TAVR) and 22% died. Severe tricuspid regurgitation was more frequent in patients with PLF-LG than in HG AS (14.7% vs. 2.2%; p < 0.01). Despite no differences in intervention rate, more patients with PLF-LG (32.4% vs. 15.9%; p = 0.049) died during the evolution. Conclusions: The PLF-LG pattern was the second most common pattern of severe AS in our cohort, and it was related to a higher mortality with no differences in intervention rate. Thus, this controversial category, rather than being underestimated, should be followed closely and considered for early intervention. Full article
(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement)
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11 pages, 1426 KiB  
Article
Aortic Stenosis and the Evolution of Cardiac Damage after Transcatheter Aortic Valve Replacement
by Fabián Islas, Patrick O’Neill-González, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Sandra Gil-Abizanda, Patricia Mahía-Casado, María Rivadeneira-Ruiz, Eduardo Pozo-Osinalde, Andreina Carbone and Carmen Olmos
J. Clin. Med. 2024, 13(12), 3539; https://doi.org/10.3390/jcm13123539 - 17 Jun 2024
Viewed by 1009
Abstract
Background/Objectives: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to predict outcomes following valve replacement. However, evidence regarding morphological and functional evolution, as well as potential changes [...] Read more.
Background/Objectives: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to predict outcomes following valve replacement. However, evidence regarding morphological and functional evolution, as well as potential changes in the degree of cardiac damage, is limited. We aim to provide information on the evolution of cardiac morphology and the function of patients undergoing transcatheter aortic valve replacement (TAVR) who have been classified using a cardiac damage staging system. Methods: In total, 496 patients were included in the analysis, and were classified into four stages based on the extent of cardiac damage as follows: Stage 0, no cardiac damage: left ventricle global longitudinal strain (LV-GLS) < −17%; right ventricular–arterial coupling (RVAc) ≥ 0.35), and absence of significant mitral regurgitation (MR). Stage 1, left-sided subclinical damage: LV-GLS ≥ −17%. Stage 2, left-sided damage: significant MR. Stage 3, right-sided damage: RVAc < 0.35. Results: The mean age was 82.1 ± 5.9 years, and 53.0% were female. In total, 24.5% of patients met the criteria for Stage 0, and Stage 1 included 42.8% of patients, Stage 2 included 16.5%, and Stage 3 comprised 16.2% of patients. Mortality was 8.4% for stage 0, 17.4% for stage 1, 25.6% for stage 2, and 28.6% for stage 3 patients (p = 0.004). Diabetes mellitus (DM) (p = 0.047) and chronic kidney disease (CKD) (p = 0.024) were the only clinical predictors of no change or worsening in the stage of cardiac damage. Regarding echocardiographic variables, concomitant tricuspid, and mitral regurgitation, ≥ 2 were both significantly associated with no change or worsening, also (p < 0.001). Conclusions: Cardiac damage that is secondary to severe aortic stenosis has morphological and functional repercussions that, even after valve replacement, persist and might worsen the prognosis. Full article
(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement)
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Review

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14 pages, 1623 KiB  
Review
Cardiac Magnetic Resonance for Structural Aortic Valve Stenosis Procedures
by Marcos Ferrández-Escarabajal, Michael Hadley and Javier Sanz
J. Clin. Med. 2024, 13(17), 5184; https://doi.org/10.3390/jcm13175184 - 1 Sep 2024
Viewed by 735
Abstract
The number of structural aortic valve procedures has increased significantly in recent years. Pre-procedural planning and follow-up with noninvasive testing are essential. Although cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular mass, volume, and function, it is not performed [...] Read more.
The number of structural aortic valve procedures has increased significantly in recent years. Pre-procedural planning and follow-up with noninvasive testing are essential. Although cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular mass, volume, and function, it is not performed routinely in patients undergoing structural interventions. CMR can provide useful information for pre- and post-procedural assessment, including quantification of cardiac function, myocardial assessment, grading of the severity of valvular heart disease, and evaluation of extracardiac anatomy while avoiding the limitations of other non-invasive modalities. Here, we review the use cases, future perspectives, and limitations of CMR for patients undergoing structural aortic valve procedures. Full article
(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement)
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13 pages, 2685 KiB  
Review
Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement
by Jose Alberto de Agustin, Eduardo Pozo Osinalde, Carmen Olmos, Patricia Mahia Casado, Pedro Marcos-Alberca, María Luaces, Jose Juan Gomez de Diego, Luis Nombela-Franco, Pilar Jimenez-Quevedo, Gabriela Tirado-Conte, Luis Collado Yurrita, Antonio Fernandez-Ortiz and Julian Perez-Villacastin
J. Clin. Med. 2023, 12(24), 7748; https://doi.org/10.3390/jcm12247748 - 18 Dec 2023
Cited by 1 | Viewed by 1967
Abstract
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the [...] Read more.
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and “valve in valve” procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration. Full article
(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement)
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