Multidisciplinary Decision-Making and Patient Selection in Complex Structural Heart Interventions

Dear Colleagues,

Contemporary structural heart interventions increasingly involve patients with advanced age, multiple comorbidities, multivalvular disease, prior cardiac surgery or transcatheter procedures, and complex anatomical substrates. In this setting, optimal outcomes depend not only on technical feasibility but—critically—on rigorous multidisciplinary decision-making and appropriate patient selection. This Special Issue focuses on the evolving role of the Heart Team in navigating complex structural heart disease, emphasizing real-world clinical judgment beyond guideline thresholds and device indications. The scope includes decision frameworks for transcatheter versus surgical or conservative management, timing of intervention, assessment of frailty and futility, and management of combined or sequential valve pathologies. Particular attention is given to challenging scenarios such as mitral annular calcification, failed prior interventions, right-sided valve disease, adult congenital heart disease, and patients with advanced heart failure or high procedural risk. Contributions integrating clinical assessment, imaging, hemodynamics, and patient-centered outcomes are encouraged. By highlighting multidisciplinary strategies and pragmatic algorithms, this Special Issue aims to provide clinicians with practical guidance for selecting the right therapy for the right patient at the right time in complex structural heart interventions.

Dr. Vlasis Ninios
Dr. Georgios Papadopoulos
Guest Editors

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