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Advances in Structural Heart Diseases
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Advances in Structural Heart Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (25 April 2026) | Viewed by 12519

Editors

Dr. Konstantinos Papadopoulos

E-Mail Website
Guest Editor
Echocardiography Department, 3rd Cardiology Clinic, Interbalkan Medical Center, Thessaloniki, Greece
Interests: structural heart diseases; valvulopathies; 3D echocardiography; interventional echocardiography; stress echocardiography
Special Issues, Collections and Topics in MDPI journals
Dr. Ignatios Ikonomidis

E-Mail Website
Guest Editor
2nd Cardiology Department, National and Kapodistrian University of Athens, 11527 Athens, Greece
Interests: 3D echocardiography; myocardial deformation; stress echocardiography; transesophageal echocardiography; transcatheter interventions in valve disease; diabetic heart; systemic inflammatory diseases; cardiomyopathies; heart failure; arterial stiffness; endothelial function
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Erwan Donal

E-Mail Website
Guest Editor
Cardiology and CIC, University of Rennes, CHU Rennes, Inserm, LTSI-UMR, 35000 Rennes, France
Interests: cardiomyopathies; arrythmias; heart valve diseases; imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The growing demand for transcatheter interventions has introduced the concepts of the “Heart Team” and “Structural Heart Diseases.” This Special Issue, titled “Advances in Structural Heart Diseases”, aims to highlight innovative transcatheter treatments, the critical role of the “Heart Team,” and the importance of cardiac imaging in the planning and management of patients.

Structural heart disease is a subspecialty encompassing conditions such as valvular heart diseases and other pathologies that require multidisciplinary evaluation and transcatheter treatments. Cardiac imaging plays a pivotal role in this field, as the planning and guidance of these procedures rely on advanced imaging modalities, including echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR).

The wide spectrum of structural heart diseases ranges from simpler congenital defects, such as atrial septal defects (ASDs) and patent foramen ovale (PFO), to complex procedures comprising valvular repair or replacement. This diversity has also fostered the development of a specialized field within imaging—“interventional echocardiography.”

We warmly invite you to contribute to this Special Issue with review articles and original research papers that focus on innovations in transcatheter treatments and underscore the indispensable role of imaging in these techniques.

You may choose our Joint Special Issue in Medicina.

Dr. Konstantinos Papadopoulos
Dr. Ignatios Ikonomidis
Prof. Dr. Erwan Donal
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 Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • valvular heart diseases
  • transcatheter interventions
  • TEER
  • LAA closure
  • ASD closure
  • interventional echocardiography
  • multimodality cardiac imaging
  • three-dimensional echocardiography

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

Jump to: Review

15 pages, 872 KB  
Article
Long-Term Outcomes of Mechanical Mitral Valve Replacement: A Comparison of Four Valve Types
by Amr A. Arafat, Fatimah A. Alhijab, Monirah A. Albabtain, Musab Kiddo, Rwan Alghamdi, Saud Alshehri, Ismail M. Alnaggar, Mostafa A. Shalaby, Huda H. Ismail and Khaled A. Alotaibi
J. Clin. Med. 2026, 15(4), 1633; https://doi.org/10.3390/jcm15041633 - 21 Feb 2026
Viewed by 765
Abstract
Background: The choice of mechanical prosthesis for mitral valve replacement (MVR) is critical, yet data comparing long-term outcomes across different valve types are still needed. This study aimed to compare the long-term clinical and echocardiographic outcomes of four distinct mechanical mitral valve prostheses. [...] Read more.
Background: The choice of mechanical prosthesis for mitral valve replacement (MVR) is critical, yet data comparing long-term outcomes across different valve types are still needed. This study aimed to compare the long-term clinical and echocardiographic outcomes of four distinct mechanical mitral valve prostheses. Methods: We retrospectively analyzed 431 patients who underwent mechanical MVR between 2009 and 2022 with one of four valve types: Carbomedics (n = 112), Bicarbon (n = 176), ATS (n = 89), or On-X (n = 54). A competing risk regression model was used to identify predictors of a composite endpoint (valve thrombosis, reoperation, stroke, pulmonary embolism, and major bleeding), accounting for all-cause mortality. Longitudinal echocardiographic data were analyzed using linear mixed-effects models. Results: The median follow-up was 62 months. The cumulative incidence of the composite endpoint at 10 years was 14% for the On-X valve, 12% for the Bicarbon valve, 9.5% for the Carbomedics valve, and 7% for the ATS valve. After adjusting for confounders, the type of valve prosthesis was not significantly associated with the composite endpoint. Significant predictors of adverse events included coronary artery disease (Sub-distribution Hazard Ratio [SHR] 2.70, p = 0.023), peripheral artery disease (SHR 6.29, p = 0.007), and smaller valve size (SHR 0.87, p = 0.037). No significant difference in overall survival was observed between the groups (log-rank p = 0.904). All valve types were associated with favorable LV remodeling. The Carbomedics group showed the greatest reduction in left ventricular end-diastolic diameter, likely reflecting regression to the mean given the larger baseline ventricular dimensions in this group. Conclusions: The type of mechanical mitral valve did not significantly influence long-term thromboembolic and bleeding events or overall survival. Patient-specific factors and valve size were the primary determinants of adverse outcomes. The observed differences in ventricular remodeling may warrant further investigation. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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14 pages, 1289 KB  
Article
Efficacy and Safety of ACURATE neo2 in Valve-in-Valve TAVI: A Prospective Single-Center Study
by Georgios E. Papadopoulos, Ilias Ninios, Sotirios Evangelou, Andreas Ioannidis, Athinodoros Nikitopoulos, George Giannakoulas and Vlasis Ninios
J. Clin. Med. 2025, 14(13), 4677; https://doi.org/10.3390/jcm14134677 - 2 Jul 2025
Cited by 1 | Viewed by 1607
Abstract
Background/Objectives: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a key approach for treating degenerated surgical bioprosthetic valves. The ACURATE neo2 valve, with its advanced sealing technology and optimized coronary access, represents a promising solution for the challenges of ViV TAVI. This [...] Read more.
Background/Objectives: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a key approach for treating degenerated surgical bioprosthetic valves. The ACURATE neo2 valve, with its advanced sealing technology and optimized coronary access, represents a promising solution for the challenges of ViV TAVI. This study evaluates the procedural and 30-day and 1-year follow-up outcomes of the ACURATE neo2 valve in ViV TAVI. Methods: This single-center, single-operator prospective study included patients with symptomatic bioprosthetic valve dysfunction, classified in New York Heart Association (NYHA) class III or IV, who underwent ViV TAVI with ACURATE neo2 at our center between July 2022 and February 2024. Outcomes were assessed using VARC-3 criteria. Results: Fifty-five patients (51% females, median (IQR) age 76 (8) years) were included. The technical success rate was 98.2%. No patients experienced in-hospital mortality, stroke, MI, bleeding, vascular complications, renal failure, or new pacemaker implantation. Three patients (5.5%) underwent elective chimney stenting for coronary protection. The postprocedural mean aortic gradient was 6.7 ± 1 mmHg, with a mean aortic valve area (AVA) of 2.0 ± 0.1 cm2. Over a median follow-up period of 1.2 years, no deaths (0%) were observed, heart failure hospitalization rate was 3.6%, and NYHA class improved to ≤II in 100% of patients. Conclusions: ACURATE neo2 demonstrated excellent technical success, sustained hemodynamic performance, and significant clinical improvement in ViV TAVI. The absence of major adverse events reinforces its safety, efficacy, and durability as a treatment for degenerated surgical bioprostheses. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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Review

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22 pages, 6863 KB  
Review
Current Trends and Future Challenges in Transcatheter Aortic Valve Implantation (TAVI): A Narrative Review
by Hani Karameh, Prerna Garg, Carla Lucarelli, Mostafa Elguindy, Iqbal Malik and Neil Ruparelia
J. Clin. Med. 2026, 15(13), 4850; https://doi.org/10.3390/jcm15134850 - 23 Jun 2026
Viewed by 702
Abstract
The advent of transcatheter aortic valve implantation (TAVI) has redefined the treatment of aortic stenosis over the last two decades, evolving from a therapy reserved for patients that were deemed to be of prohibitive surgical risk to the standard of care for a [...] Read more.
The advent of transcatheter aortic valve implantation (TAVI) has redefined the treatment of aortic stenosis over the last two decades, evolving from a therapy reserved for patients that were deemed to be of prohibitive surgical risk to the standard of care for a large group of patients presenting with symptomatic disease. With improvements in technology, operator and institutional experience and longer-term outcome data, recent guidelines have supported the broadening of indications to low-risk and asymptomatic patients in addition to other pathologies including the management of failed surgical bioprosthetic valves and aortic regurgitation. The rapid developments in the field have resulted in a rapid expansion of TAVI. The focus has moved from the technical aspects of the procedure itself that are now well established to the lifetime management of patients with aortic stenosis, particularly younger patients with regard to valve durability, planning for a further intervention after TAVI and associated considerations including future coronary access. Beyond aortic stenosis, TAVI technology is also increasingly being utilized for the management of failed surgical bioprostheses, bicuspid valve disease, aortic incompetence and mitral/tricuspid disease and these represent future areas of focus in the field. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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16 pages, 654 KB  
Review
Thrombotic Versus Bleeding Risk After Transcatheter Aortic Valve Implantation
by Kotsi Sofia Fotoula, Abdalazeem Ibrahem, Allam Harfoush, Hussain Hussain, Ammar Ezeldin, Hilal Khan, Diana A. Gorog and Mohamed Farag
J. Clin. Med. 2026, 15(5), 1767; https://doi.org/10.3390/jcm15051767 - 26 Feb 2026
Cited by 1 | Viewed by 810
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is increasingly used across all risk groups, meaning more patients are living long-term with transcatheter bioprosthetic valves. These patients are often multimorbid and vulnerable to both thrombotic and bleeding complications. Optimal antithrombotic therapy remains uncertain due to [...] Read more.
Background: Transcatheter aortic valve implantation (TAVI) is increasingly used across all risk groups, meaning more patients are living long-term with transcatheter bioprosthetic valves. These patients are often multimorbid and vulnerable to both thrombotic and bleeding complications. Optimal antithrombotic therapy remains uncertain due to differences in trial design, patient demographics, and procedural practices. Methods: We undertook a narrative review that included randomised controlled trials, observational studies, biomarker research, and guideline recommendations on post-TAVI antithrombotic therapy. We evaluated the available evidence for antiplatelet and anticoagulant strategies after TAVI, predictors of bleeding and thrombotic complications, to identify emerging approaches using biomarkers for personalised risk stratification. Results: Thrombotic events after TAVI are predominantly early and procedural in origin, while new-onset atrial fibrillation (AF) leads to substantial late risk. Subclinical leaflet thrombosis is frequent, but its clinical significance remains uncertain, as anticoagulation reduces CT-detected leaflet abnormalities without improving clinical outcomes. Early bleeding within the first 30 days remains a principal contributor to mortality, influenced by frailty, vascular access, comorbidity, and intensity of antithrombotic therapy. Randomised evidence consistently supports a minimalist, indication-driven regimen: single antiplatelet therapy for patients without an oral-anticoagulation (OAC) indication, and OAC monotherapy for those with AF. Routine OAC use in unselected patients carries no advantage and exposes them to harm. Biomarkers and machine-learning models show promise for future individualised risk assessment. Conclusions: Antithrombotic strategies post-TAVI should prioritise minimising bleeding while maintaining adequate thromboembolic protection. Single antiplatelet therapy for patients without an indication for OAC and OAC alone for those with AF offer the best balance of safety and efficacy. Ongoing trials may clarify the role of imaging-guided therapy and biomarker-based risk stratification and refine antithrombotic strategies. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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14 pages, 938 KB  
Review
Tricuspid Transcatheter Edge-to-Edge Repair at a Crossroads: Prognosis-Shaping Intervention or High-Tech Palliation?
by Andreas Mitsis, Marios Ioannides, Christis Rotos, Nikolaos P. E. Kadoglou and Christos Eftychiou
J. Clin. Med. 2026, 15(2), 443; https://doi.org/10.3390/jcm15020443 - 6 Jan 2026
Viewed by 1237
Abstract
Tricuspid regurgitation (TR) has historically been undertreated despite its strong association with morbidity and mortality. Surgical correction of isolated TR is not routinely performed and has shown limited survival benefit, leaving a substantial unmet need for minimally invasive therapies. Transcatheter edge-to-edge repair (T-TEER) [...] Read more.
Tricuspid regurgitation (TR) has historically been undertreated despite its strong association with morbidity and mortality. Surgical correction of isolated TR is not routinely performed and has shown limited survival benefit, leaving a substantial unmet need for minimally invasive therapies. Transcatheter edge-to-edge repair (T-TEER) has emerged as a promising therapeutic option for patients with symptomatic severe or greater (≥severe) TR who are unsuitable for surgery. Recent randomized trials, including the TRILUMINATE Pivotal and the Tri-FR study, and real-world registries consistently demonstrate significant improvements in TR severity, functional status, and quality of life following T-TEER. Although benefits in hard clinical endpoints such as mortality or heart failure hospitalizations remain less conclusive, growing evidence suggests potential prognostic advantage in selected patients, particularly those with preserved or mid-range right ventricular function. Anatomical suitability, RV performance, and optimized patient selection are crucial determinants of success. As ongoing large-scale trials continue to evaluate long-term outcomes, T-TEER currently occupies a therapeutic space between palliative intervention and disease-modifying therapy, providing substantial symptom relief with the potential for broader clinical benefit. This review summarizes current evidence, patient selection strategies, and perspectives on the evolving role of T-TEER in the management of severe TR. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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21 pages, 21264 KB  
Review
Screening and Procedural Guidance for Mitral Transcatheter Edge-to-Edge Repair (M-TEER)
by Andromahi Zygouri, Prayuth Rasmeehirun, Guillaume L’Official, Konstantinos Papadopoulos, Ignatios Ikonomidis and Erwan Donal
J. Clin. Med. 2025, 14(14), 4902; https://doi.org/10.3390/jcm14144902 - 10 Jul 2025
Cited by 4 | Viewed by 6672
Abstract
Mitral regurgitation (MR) is a common valvular heart disease associated with significant morbidity and mortality. For patients at high or prohibitive surgical risk, mitral transcatheter edge-to-edge repair (M-TEER) offers a less invasive alternative to surgery. This review outlines key aspects of patient selection [...] Read more.
Mitral regurgitation (MR) is a common valvular heart disease associated with significant morbidity and mortality. For patients at high or prohibitive surgical risk, mitral transcatheter edge-to-edge repair (M-TEER) offers a less invasive alternative to surgery. This review outlines key aspects of patient selection and procedural planning for M-TEER, with a focus on clinical and echocardiographic criteria essential for success. Comprehensive imaging—especially 2D and 3D transesophageal echocardiography—is critical to assess leaflet anatomy, coaptation geometry, and mitral valve area. Selection criteria differ between primary and secondary MR and are guided by trials such as COAPT and MITRA-FR. Optimal outcomes rely on careful screening, anatomical suitability, and multidisciplinary evaluation. With growing experience and advancing technology, M-TEER has become a transformative option for treating severe MR in non-surgical candidates. Full article
(This article belongs to the Special Issue Advances in Structural Heart Diseases)
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