Recent Advances in Valve Therapy: Clinical and Molecular Perspectives

Dear Colleagues,

In the past decade, the scientific validation of transcatheter aortic valve implantation (TAVI) has significantly influenced the management of patients with symptomatic aortic stenosis, yet this is just one of several promising valve therapies emerging today. Alongside TAVI, advancements in other valve intervention techniques are shaping treatment paradigms across a range of structural heart diseases. As new technologies evolve, they bring fresh opportunities and challenges in both clinical and molecular research.

This Special Issue aims to address current knowledge gaps and encourage contributions that expand our understanding of the management of structural heart disease, especially regarding advanced valve therapies, including TAVI and emerging alternative procedures. We particularly encourage submissions that cover three major areas of focus: (1) expanded clinical indications, (2) the optimization of outcomes, and (3) molecular mechanisms underlying these therapies.

1. Expansion of Clinical Indications. TAVI indications have expanded over time to include a wider range of patient risk profiles, and clinical trials continue to explore additional groups, such as asymptomatic or moderate-risk patients, those with a congenital background, and patients with concurrent valvular or coronary disease. We encourage research exploring outcomes for these groups and evaluating emerging indications for TAVI as well as alternative valve therapies. Of particular interest is the role of advanced molecular diagnostics and imaging techniques in selecting appropriate candidates for each type of procedure.
2. Outcome Optimization. While TAVI and other valve therapies have proven to improve clinical outcomes, questions remain regarding the durability of valve implants, particularly in younger patients, and the management of coexisting conditions like coronary artery disease. This section will explore strategies for optimizing outcomes in valve therapies, including improvements in device design, antithrombotic strategies, and neuroprotection techniques. We invite research on predictive factors for long-term success, as well as molecular mechanisms and biomarkers that can help forecast patient responses to these therapies.
3. Molecular Mechanisms and Biological Insights. Understanding the molecular basis of valve pathology and repair mechanisms is crucial in advancing these therapies. This section welcomes studies on the cellular and molecular mechanisms involved in valve degeneration, tissue remodeling, and inflammatory responses following TAVI and other valve interventions. We aim to highlight the biological processes involved in device interaction with native tissue, as well as potential molecular targets that could enhance the efficacy and safety of valve therapies.
4. Valve-in-Valve and TAVI-in-TAVI Procedures. Techniques such as valve-in-valve and TAVI-in-TAVI have extended the therapeutic potential of transcatheter approaches for patients with failing bioprosthetic valves. Research on these procedures will focus on technical considerations, anatomical requirements, and patient selection criteria, as well as the molecular and cellular impacts of these iterative treatments.

We hope that this Special Issue will provide a platform for advancing knowledge in these dynamic areas, from cutting-edge clinical techniques to the underlying biological processes. We look forward to your contributions to shaping the future of valve therapy.

Dr. Panayotis Vlachakis
Prof. Dr. Konstantinos Toutouzas
Prof. Dr. Constantina Aggeli
Guest Editors

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• transcatheter aortic valve implantation (TAVI)
• valve-in-valve
• long-term outcomes
• aortic stenosis
• molecular mechanisms in valve disease
• structural heart disease