Current Advances in Valvular Heart Diseases

Dear Colleagues,

Valvular heart diseases are a major public health problem associated with an increased risk of morbidity and mortality when not treated. Over the last decade, there has been a growing appreciation for the importance of the underlying mechanism of valvular heart disease and imaging, and the independent association of tricuspid valve regurgitation to reduced survival. Early and timely valvular heart disease intervention is associated with improved outcomes. However, due to their silent nature, valvular heart diseases frequently go underdiagnosed or are diagnosed late, often leading to no intervention or delayed intervention.

This Special Issue highlights strategies for the early diagnosis of valvular heart disease, such as machine learning or artificial intelligence, and the broadening understanding of mechanisms of valvular heart disease and their impact on the type and timing of intervention. 

The topics of interest for this Special Issue include, but are not limited to, the following:

1. Machine learning and artificial intelligence applications in valvular heart disease;
2. Evaluation and management of primary and secondary mitral regurgitation;
3. Evaluation and management of primary and secondary tricuspid valve regurgitation;
4. Transcatheter valve therapies for aortic, mitral, and tricuspid valve disease;
5. Minimally invasive surgical strategies for the treatment of valvular heart disease.

Dr. Vuyisile T. Nkomo
Guest Editor

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• valve disease
• aortic valve stenosis
• aortic valve regurgitation
• mitral valve stenosis
• mitral valve regurgitation
• mitral annular calcification
• tricuspid valve regurgitation
• machine learning
• artificial intelligence
• echocardiography

Title 1: Sutureless Aortic Bioprosthesis In Isolated Aortic Valve Replacement By Minimally Invasive Approach: Results From A Prospective International Real-World Registry
Abstract: Objectives: Sutureless valve has been in clinical use for more than 15 years. The aim of this study is to report clinical and haemodynamic performance from a real-world registry in patients who underwent aortic valve replacement (AVR) with a sutureless bioprosthesis, comparing outcomes of ministernotomy versus minithoracotomy settings. Methods: This prospective international registry enrolled 1652 patients implanted with a sutureless aortic valve in 55 Institutions from 2011 to 2021. Postoperative follow-up and echocardiographic outcomes were collected. Patients with isolated AVR were analyzed by minimally invasive (MICS) approache. Preoperative covariates were adjusted with propensity score maching 3:1, reaching a final cohort of .... ministernotomy AVR patients with ..... patients in minithoracotomy approach. Results: In the overall cohort patients mean age was .... years (...% female); mean EuroSCORE II was ...... Isolated AVR was performed in ...% of cases, .... of which were performed via a minimally invasive approach. First successful implantation was achieved in ....% of cases. Within 30 days, ... and ... valve related reinterventions were reported. Pacemaker implant was required in ... of patients. Intraprosthetic regurgitation ≥ 2 was present in ... of cases while paravalvular leak ≥ 2 in ....%. At a maximum follow-up of 8 years, ...% of cardiovascular deaths and ...% of valve-related reintervention occurred. Among the ... cases of structural valve deterioration (mean .... years after implant), ... were treated with a transcatheter valve-in-valve implantation and ... with explant. Mean pressure gradient decreased from .... mmHg preoperatively to ... mmHg at discharge and remained stable during follow-up. Results of the propensity match analysis showed that the ministernotomy approach has/or not ..... effect on survival, disabling stroke, leaks greater than 2, pacemaker rate and hemodynamics, ....... Conclusions: This registry represents the largest prospective real-world cohort of patients treated with a sutureless valve. Our propensity matched analysis demonstrates the in ministernotomy vs minithoracotomy