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Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition

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A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (20 April 2026) | Viewed by 7353

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Dr. Jose Alberto De Agustín

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Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, 28040 Madrid, Spain
Interests: valvular disease; cardiac imaging; echocardiography
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Special Issue, titled “Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition”. This is a new edition. In our previous Special Issue, titled “Global Expert Views on Aortic Valve Repair and Replacement”, we published five papers and collected high-quality original articles and review papers covering a wide range of topics. For more details, please visit: https://www.mdpi.com/journal/jcm/special_issues/2L05H964Q2. This is a continuation of the previous series.

The treatment of aortic valve pathologies has undergone important changes in recent years. Open cardiac surgery has given 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

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Keywords

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

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Related Special Issue

Global Expert Views on Aortic Valve Repair and Replacement in Journal of Clinical Medicine (5 articles)

Published Papers (5 papers)

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Research

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11 pages, 919 KB

Open AccessArticle

Impact of Supranormal LVEF After TAVI: Behavior, Mortality, and Cardiac Structure

by Ximena Solar Sigala, Edgar Martínez, Carmen Olmos Blanco, Eduardo Pozo, Pedro Marcos-Alberca, José Juan Gómez de Diego, Patricia Mahía, Luis Nombela-Franco, Pilar Jiménez Quevedo, Gabriela Tirado, Luis Collado Yurrita, Maria Luaces, Antonio Fernández-Ortiz and Julián Pérez-Villacastín

J. Clin. Med. 2026, 15(7), 2700; https://doi.org/10.3390/jcm15072700 - 2 Apr 2026

Viewed by 558

Abstract

Background/Objectives: Left ventricular ejection fraction (LVEF) typically improves after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (SAS). However, the clinical significance and prognosis of patients presenting with supranormal LVEF (≥65%) remain poorly defined. This study aims to describe LVEF behavior, its relationship with mortality, and its effect on cardiac structure in this specific subgroup. Methods: A retrospective observational study was conducted at Hospital Clínico San Carlos (2008–2019), including SAS patients with pre-procedural supranormal LVEF. Patients were classified into two groups: those whose LVEF normalized (55–65%) and those whose LVEF remained supranormal. Demographic, clinical, and echocardiographic variables were collected at baseline and one-year follow-up. The primary endpoint was all-cause mortality at two years. Results: Out of 101 analyzed patients (mean age 82.8 years, 71.2% women), 71 (70.3%) experienced LVEF normalization at one year. Two-year mortality was 10% in the normalized group and 9.8% in the non-variable group, showing no significant difference. Regarding geometric characteristics, a trend toward left ventricular mass regression was observed only in the LVEF-normalized group (Delta −10; p = 0.062 vs. −8.4; p = 0.197). History of bleeding was the only variable showing a trend toward worse prognosis (p = 0.064). Conclusions: LVEF behavior one year after TAVI in patients with baseline supranormal function tends toward normalization. This change is not associated with differences in two-year mortality but is linked to a trend toward beneficial reverse cardiac remodeling. Full article

(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition)

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12 pages, 1615 KB

Open AccessArticle

Aortic Stenosis-Associated Cardiac Damage: A Comparison Between Patients Treated with Surgery and Transcatheter Aortic Valve Replacement

by Ricardo Román, Fabián Islas, Patrick O’Neill-González, Carlos E. Gil, Manuel Carnero, Pilar Jiménez-Quevedo, Luis Nombela-Franco, Daniel Pérez-Camargo, Lourdes Montero-Cruces, María Rivadeneira-Ruiz, Sandra Gil-Abizanda, Eduardo Pozo and Carmen Olmos

J. Clin. Med. 2026, 15(5), 1961; https://doi.org/10.3390/jcm15051961 - 4 Mar 2026

Viewed by 1920

Abstract

Background/Objectives: In patients with severe aortic stenosis (AS), extra valvular cardiac damage is associated with outcomes following intervention. We aimed to analyze differences in AS-related cardiac damage between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients in a contemporary cohort of patients with severe AS. Methods: Patients who underwent SAVR or TAVR in a tertiary care center from 2017 to 2022 were included in this retrospective analysis. Clinical and echocardiographic parameters before surgery were compared, and patients were classified according to two available cardiac damage staging systems. Additionally, all-cause mortality 1-year post-intervention was assessed according to these stages. Results: Eight hundred and seventy-four patients were included (524 underwent TAVR and 350 underwent SAVR). TAVR patients were significantly older (81.9 ± 6.1 vs. 69.5 ± 9.5 years; p < 0.001), more commonly female (52.4% vs. 37.7%; p < 0.001), and had higher surgical risk (EuroSCORE II 6.2 ± 7.0 vs. 2.7 ±3.3; p < 0.001). Compared with SAVR, patients treated with TAVR had significantly more advanced (right-sided) cardiac damage, both with Généreux (37.8% vs. 23.1%; p < 0.001) and Gutiérrez-Ortiz (16.5% vs. 9.0%; p = 0.007) staging systems. Moreover, regardless of the type of intervention or the staging system used, mortality was significantly higher in patients with right-sided damage. Conclusions: In a contemporary cohort of severe symptomatic AS patients, those treated with TAVR had significantly more extensive cardiac damage compared with those who underwent SAVR. This finding raises the question of when to intervene in patients chosen for TAVR. Earlier intervention, before advanced cardiac damage ensues, might help to improve outcomes. Full article

(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition)

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12 pages, 826 KB

Open AccessArticle

External Validation of Two Different Cardiac Damage Staging Systems for Aortic Stenosis in Patients Treated with Surgical Aortic Valve Replacement

by Carlos Gil, Carmen Olmos, Patrick O’Neill, Ricardo Román, Manuel Carnero, Daniel Pérez-Camargo, Lourdes Montero, María Rivadeneira, Sandra Gil-Abizanda, Eduardo Pozo and Fabián Islas

J. Clin. Med. 2026, 15(5), 1795; https://doi.org/10.3390/jcm15051795 - 27 Feb 2026

Viewed by 451

Abstract

Background: Several cardiac damage staging systems for aortic stenosis (AS) have been proposed, but their usefulness in patients undergoing surgical aortic valve replacement (SAVR) remains unknown. Objectives: We aim to externally validate two staging systems in patients who underwent SAVR. Methods: Single-centre prospective cohort of patients treated with SAVR (2017–2022). Based on baseline echocardiographic parameters, patients were classified into the different stages of two published staging systems (Généreux et al. and Gutiérrez et al.), and the discriminatory yield of these systems for 1-year mortality was evaluated. Results: In total, 350 patients were analysed (mean age 69 (9.4) years, 37.8% were female). The median EuroSCORE II was 1.7 (1.1–3.1), and 1-year mortality occurred in 17 (4.8%) patients. The staging system developed by Gutiérrez et al. had an area under the ROC curve (AUC) of 0.687 (95% CI: 0.571–0.803) and was superior to Généreux et al.’s system (AUC of 0.554; 95% CI: 0.439–0.669; p = 0.008). Applying Gutiérrez et al.’s system, 1-year mortality rates progressively increased with higher damage staging: 1.9% (2/103) for Stage 0; 5.1% (5/175) for Stage 1; 12.5% (5/40) for Stage 2; and 15.6% (5/32) for Stage 3 (which represents right-sided damage measured by right ventricular–arterial coupling (RVAc); p= 0.038). No significant differences in outcomes between stages were found when using the staging proposed by Généreux et al. (p = 0.218). Conclusions: In a surgical cohort of patients with AS, a cardiac staging system that included RVAc showed greater discriminatory power for 1-year mortality. Assessing the interrelation between right ventricular function and afterload could help in better risk stratification in this context. Full article

(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition)

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16 pages, 1626 KB

Open AccessArticle

Evolution of Cardiac Damage Across Clinically Defined Stages of Aortic Stenosis in Patients Undergoing TAVR: A Single-Center Retrospective Cohort Study

by María Rivadeneira-Ruiz, Carmen Olmos, Sandra Gil-Abizanda, Pilar Jiménez-Quevedo, Eduardo Pozo-Osinalde, Luis Nombela-Franco, José Alberto de Agustín and Fabián Islas

J. Clin. Med. 2026, 15(4), 1575; https://doi.org/10.3390/jcm15041575 - 17 Feb 2026

Viewed by 631

Abstract

Background: Echocardiography is essential for diagnosing and guiding therapy in aortic stenosis (AS). Cardiac damage staging systems may better characterize myocardial and extracardiac involvement. We aim to evaluate the presence and progression of cardiac damage across the clinical course of AS. Methods: A single-center retrospective cohort study was conducted, which included consecutive patients who ultimately underwent TAVR and had retrievable serial echocardiograms at moderate AS, first severe AS, and pre-TAVR symptomatic severe AS (2017–2021). A total of 179 patients were evaluated (mean age 82.7 [5.9] years at moderate AS; 46% male, p = 0.27). Cardiac damage was classified according to two established staging systems. Results: The median time from moderate to severe AS was 32 months (IQR 18–48). Most echocardiographic parameters deteriorated primarily at symptom onset, whereas moderate AS and first severe (asymptomatic) AS showed broadly similar profiles. However, left ventricular global longitudinal strain (LV GLS) was already impaired at the first severe stage, and right ventricular–arterial coupling (RVAc, TAPSE/sPAP) progressively worsened as AS advanced to the severe stage, independently of symptom status (LV GLS −18.1%, n = 163; −17.1%, n = 143; and −14.9%, n = 143; RVAc 1.0, n = 131; 0.8, n = 130; and 0.7, n = 130), respectively; overall p < 0.05. Both staging systems demonstrated increasing cardiac damage with AS progression. Conclusions: Cardiac damage may occur early in AS. The marked deterioration at symptom onset underscores the importance of systematic myocardial assessment and supports prospective studies to evaluate whether integrating LV GLS and RVAc as sensitive early markers of disease progression improves risk stratification. Full article

(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition)

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Review

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20 pages, 2918 KB

Open AccessReview

Aortopathy in Bicuspid Aortic Valve: Pathophysiology, Risk Stratification and Surgical Decision-Making—A Narrative Review

by Sebastian Krych, Julia Gniewek, Michał Jurkiewicz, Paweł Kowalczyk, Dariusz Waniczek and Tomasz Hrapkowicz

J. Clin. Med. 2026, 15(9), 3542; https://doi.org/10.3390/jcm15093542 - 6 May 2026

Cited by 2 | Viewed by 3138

Abstract

Bicuspid aortic valve (BAV) is one of the most common congenital heart defects, introducing significant hemodynamic disturbances to the circulatory system. This narrative review analyzed articles published between 2012 and 2025 and indexed in PubMed. The aim was to synthesize key information on the etiopathogenesis of BAV, its potential complications and associated risks, as well as available pharmacological and surgical treatment strategies, with emphasis on indications and contraindications for specific surgical techniques. Analyses demonstrate that isolated BAV with typical valvular aortopathy is associated with a more favorable prognosis compared to valvular aortopathy syndromes. Valve phenotype shows important sex-related relationships in its presentation and progression. From a hemodynamic perspective, BAV alters blood flow angles, which may contribute to weakening of the aortic wall and secondary valve changes. BAV is also frequently associated with genetic disorders such as Marfan syndrome. The heterogeneity of aortopathies linked to BAV creates significant challenges for echocardiographers, cardiologists and cardiac surgeons, particularly in determining the optimal timing and strategy for surgical intervention. Full article

(This article belongs to the Special Issue Global Expert Views on Aortic Valve Repair and Replacement: 2nd Edition)

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