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

A Special Issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425) belonging to the section "Cardiovascular Clinical Research".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 2249

Editors

Dr. Vlasis Ninios

E-Mail Website
Guest Editor
2nd Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
Interests: transcatheter mitral valve replacement and repair; transcatheter therapy of heart failure; transcatheter tricuspid valve replacement and repair
Special Issues, Collections and Topics in MDPI journals
Dr. Georgios Papadopoulos

E-Mail Website
Guest Editor
Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
Interests: interventional cardiology; structural heart disease; pulmonary hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

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

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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized 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 Cardiovascular Development and Disease is an international peer-reviewed open access monthly 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 2700 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

  • structural heart disease
  • multidisciplinary heart team
  • complex valvular heart disease
  • transcatheter valve interventions
  • transcatheter edge-to-edge repair
  • transcatheter valve replacement
  • adult congenital heart disease
  • TAVI
  • TMVR
  • TTVR

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Published Papers (3 papers)

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Research

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13 pages, 1580 KB  
Article
Nutritional Indices Are Associated with Mortality in the Elderly Patients Undergoing Left Atrial Appendage Occlusion: A Comparative Study of CONUT, GNRI, and PNI
by Ugur Karagoz, Enise Nur Ozlem Tiryaki, Enis Behcet Agirdici, Berke Ege, Muhammet Mucahit Tiryaki, Emre Ozdemir and Sadık Volkan Emren
J. Cardiovasc. Dev. Dis. 2026, 13(5), 177; https://doi.org/10.3390/jcdd13050177 - 24 Apr 2026
Viewed by 874
Abstract
Background: We investigated the prognostic value of nutritional indices in patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage occlusion (LAAO). Methods: This two-center retrospective study enrolled 151 patients (median age 75, IQR: 69–80) undergoing LAAO. The Controlling Nutritional Status (CONUT) score, [...] Read more.
Background: We investigated the prognostic value of nutritional indices in patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage occlusion (LAAO). Methods: This two-center retrospective study enrolled 151 patients (median age 75, IQR: 69–80) undergoing LAAO. The Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) were calculated preoperatively. Endpoints included all-cause mortality (primary), postoperative bleeding, and stroke. Associations with mortality were analyzed using multivariable Cox regression models. Results: Over a median follow-up of 8 months (IQR: 5–13), 28 patients (18.5%) died. In multivariable analyses (adjusted for age, sex, diabetes, and chronic kidney disease), each 1-point increase in the CONUT score was associated with a higher risk of all-cause mortality (HR 1.196, 95% CI 1.029–1.390; p = 0.020), whereas higher GNRI values were associated with a lower mortality risk (HR 0.956, 95% CI 0.915–0.998; p = 0.042). In contrast, PNI was not associated with mortality (p = 0.993). Nutritional indices did not significantly predict secondary outcomes like bleeding or stroke. Conclusions: These findings suggest that malnutrition is strongly and independently associated with mortality in high-risk AF patients receiving LAAO. The CONUT score demonstrates the most robust association in this population, highlighting the importance of metabolic reserves. Full article
(This article belongs to the Special Issue Multidisciplinary Decision-Making and Patient Selection in Complex Structural Heart Interventions)
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Review

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17 pages, 5914 KB  
Review
Mitral Transcatheter Edge-to-Edge Repair in Non-Surgical Candidates with Hypertrophic Obstructive Cardiomyopathy: Clip It, or Ablate It?
by Emmanouil Chourdakis, Kambis Mashayekhi, Ulrich Schäfer and Christos Katsouras
J. Cardiovasc. Dev. Dis. 2026, 13(6), 255; https://doi.org/10.3390/jcdd13060255 - 8 Jun 2026
Viewed by 583
Abstract
Hypertrophic cardiomyopathy (HCM), with or without obstructive phenomena, remains underdiagnosed and undertreated. This condition often involves pathological changes in the mitral valve leaflets and apparatus, which can lead to relevant mitral regurgitation (MR). The mechanism of MR is mostly related to the systolic [...] Read more.
Hypertrophic cardiomyopathy (HCM), with or without obstructive phenomena, remains underdiagnosed and undertreated. This condition often involves pathological changes in the mitral valve leaflets and apparatus, which can lead to relevant mitral regurgitation (MR). The mechanism of MR is mostly related to the systolic anterior motion (SAM) of the anterior mitral leaflet. The treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) with persistent symptoms despite optimal pharmacological therapy includes septal myectomy or transcoronary ablation of septal hypertrophy (TASH). Percutaneous edge-to-edge repair of the mitral valve represents an innovative alternative therapy with promising results regarding clinical symptoms and echocardiographic findings. In this article, we provide a concise, critical overview of the current evidence on this technique in HOCM and delineate future perspectives and unresolved issues. Full article
(This article belongs to the Special Issue Multidisciplinary Decision-Making and Patient Selection in Complex Structural Heart Interventions)
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Other

Jump to: Research, Review

7 pages, 456 KB  
Brief Report
Prognostic Performance of a Modified TRI-SCORE Incorporating RV–PA Uncoupling After Transcatheter Tricuspid Valve Interventions
by Mhd Nawar Alachkar, Johannes Schlegl, Marwin Bannehr, Tanja Kücken, Michael Lichtenauer, Vera Paar, Michael Neuß, Anja Haase-Fielitz, Christoph Edlinger and Christian Butter
J. Cardiovasc. Dev. Dis. 2026, 13(6), 250; https://doi.org/10.3390/jcdd13060250 - 5 Jun 2026
Viewed by 346
Abstract
Background: The TRI-SCORE was developed to predict mortality after tricuspid valve surgery and has demonstrated prognostic value in patients undergoing transcatheter tricuspid valve interventions (TTVI). Right ventricular–pulmonary arterial (RV–PA) uncoupling assessed by the TAPSE/sPAP ratio has emerged as a prognostic marker in selected [...] Read more.
Background: The TRI-SCORE was developed to predict mortality after tricuspid valve surgery and has demonstrated prognostic value in patients undergoing transcatheter tricuspid valve interventions (TTVI). Right ventricular–pulmonary arterial (RV–PA) uncoupling assessed by the TAPSE/sPAP ratio has emerged as a prognostic marker in selected populations; however, its incremental value within established risk scores remains unclear. Methods: In this prospective single-centre cohort, 109 patients undergoing TTVI were included. The original TRI-SCORE was calculated for all patients. A modified TRI-SCORE was proposed by substituting the definition of right ventricular dysfunction based on TAPSE with RV–PA uncoupling, defined as TAPSE/sPAP <0.406 using invasively measured systolic pulmonary artery pressure. The endpoints were 12-month all-cause mortality and a combined endpoint of death or cardiovascular rehospitalization. Results: At 12 months, all-cause mortality occurred in 19.3% of patients, and the combined endpoint in 40.4%. Both original and modified TRI-SCOREs were significantly associated with 12-month mortality (OR 1.80 per point increase, 95% CI 1.30–2.48; p < 0.001 and OR 1.81 per point increase, 95% CI 1.31–2.49; p < 0.001, respectively) and demonstrated comparable discrimination (AUC 0.78 for both; DeLong p = 0.90). Furthermore, both scores were significantly associated with the combined endpoint (TRI-SCORE: OR 1.36 per point increase, 95% CI 1.08–1.71; p = 0.008; modified TRI-SCORE; OR of 1.33 per one-point increase, 95% CI 1.07–1.66; p = 0.009) with modest and comparable AUCs (~0.65). Conclusion: In patients undergoing TTVI, replacing TAPSE with RV–PA uncoupling did not improve the prognostic performance of the TRI-SCORE for mortality or combined clinical outcomes. Full article
(This article belongs to the Special Issue Multidisciplinary Decision-Making and Patient Selection in Complex Structural Heart Interventions)
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