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Dear Colleagues,

Transcatheter aortic valve replacement has transformed the management of aortic valve disease and emerged as an option for patients in all risk categories. Surgical aortic valve replacement remains the gold standard for many patients with aortic valve disease, and choosing between surgery and transcatheter aortic valve replacement can sometimes be challenging, as both have their unique advantages and disadvantages.

It is my pleasure to announce that I will be serving as the guest editor for a Special Issue of the Journal of Clinical Medicine dedicated to the clinical advances in surgical and transcatheter aortic valve replacement. As an expert in this field, I believe that you would make a significant and impactful contribution to this Special Issue.

The aim of this issue is to bring the reader up to date with the advances in surgical and transcatheter aortic valve replacement and to provide comprehensive yet clear practical information related to the evaluation and management of the patient with aortic valve disease. In addition, the reader should be appraised of the relevant latest technological developments that have the potential to impact surgery or transcatheter aortic valve replacement in the near future. This Special Issue will cover the following topics:

When to intervene in an asymptomatic patient with aortic stenosis.
When to intervene in asymptomatic patient with aortic valve regurgitation.
Advances in minimally invasive surgical aortic valve replacement.
Choice of mechanical versus tissue prosthesis.
Advances in surgical aortic valve repair for aortic valve regurgitation.
Advances in transcatheter aortic valve replacement for aortic valve regurgitation.
Advances in transcatheter aortic valve replacement for bicuspid aortic valve stenosis.
Incidence, management, and avoidance of high-grade atrioventricular block after transcatheter aortic valve replacement.
Redo aortic valve replacement for a diseased aortic valve prosthesis: when to choose surgical versus transcatheter aortic valve replacement.
Anticoagulation strategies following surgical or transcatheter aortic valve replacement.
Bioprosthetic valve thrombosis: incidence, management, and long-term implications.
Tissue-engineered heart valve for aortic valve replacement.

Dr. Vuyisile T. Nkomo
Guest Editor

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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind 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 disease
aortic valve stenosis
aortic valve regurgitation
bicuspid aortic valve
minimally invasive surgery
surgical aortic valve replacement
transcatheter aortic valve replacement
aortic valve prosthesis
long-term outcomes

Published Papers (2 papers)

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Research

Open AccessArticle

Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40%

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J. Clin. Med. 2023, 12(6), 2390; https://doi.org/10.3390/jcm12062390 - 20 Mar 2023

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Abstract

Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in patients with an ejection fraction (EF) of ≤20% (VLEF group) to patients with an EF > 20% to ≤40% (LEF group). We included patients with severe AS and reduced LV ejection fraction (LVEF ≤ 40%) who underwent TAVR at four centers within Northwell Health between January 2016 and December 2020. Over 2000 consecutive patients were analyzed, of which 355 patients met the inclusion criteria. The primary composite endpoint was in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve re-intervention, and/or need for PPM. Secondary endpoints were length of stay, NYHA classification at 1 month and 1 year, mortality at 1 month and 1 year, mean valve gradient at 1 month, KCCQ score at 1 month, and ≥ moderate PVL at 1 month. There was no difference in the primary composite endpoint between the two groups (23.6% for VLEF vs. 25.3% for LEF, p = 0.29). During TAVR placement, 40% of patients in the VLEF group required ≥1 vasopressors for hypotension lasting ≥30 min vs. only 21% of patients in the LEF group (p < 0.01). Intra-aortic balloon pump (IABP) use during procedure was greater in the VLEF group (9% vs. 1%, p < 0.01)—all placed post TAVR. Emergency ECMO use was higher in the VLEF group as well (5% vs. 0%). Total length of stay was significantly different between the two groups as well (6 days vs. 3 days, p < 0.01). Both groups had a change in LVEF of ~10%. One-year outcomes were similar between the groups. All-cause mortality at 1 year was not significantly different at 1 year (13% for VLEF vs. 11% for LEF), and KCC scores were also similar (77.54 vs. 74.97). Mean aortic valve gradients were also similar (12 mmHg vs. 11 mmHg, p = 0.48). Our study suggests that patients with EF ≤ 20% can safely have TAVR with similar periprocedural outcomes compared to patients with EF > 20% to ≤40% despite higher rates of vasopressor and mechanical support. Full article

(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)

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Open AccessArticle

Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience

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J. Clin. Med. 2023, 12(3), 1157; https://doi.org/10.3390/jcm12031157 - 01 Feb 2023

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Abstract

Introduction: Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study’s primary goal was to provide an initial summary of the medium- and short-term clinical effectiveness of transcatheter aortic valve replacement (TAVR) guided by accurate multi-detector computed tomography (MDCT) measurements in patients with severe and chronic AR, especially in elderly patients. Methods: The study enrolled retrospectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital, Beijing. Baseline information, MDCT measurements, anatomical classification, perioperative, and 1-year follow-up outcomes were collected and analyzed. Based on a novel anatomical categorization and dual anchoring theory, patients were divided into four categories according to the level of anchoring area. Type 1, 2, and 3 patients (with at least two anchoring regions) will receive TAVR with a transcatheter heart valve (THV), but Type 4 patients (with zero or one anchoring location) will be deemed unsuitable for TAVR and will instead receive medical care (retrospectively enrolled patients who already underwent TAVR are an exception). Results: The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years, and 23 patients (62.2%) were male. The American Association of Thoracic Surgeons’ score was 8.6 ± 2.1%. The MDCT anatomical classification included 17 cases of type 1 (45.9%), 3 cases of type 2 (8.1%), 13 cases of type 3 (35.1%), and 4 cases of Type 4 (10.8%). The VitaFlow valve (MicroPort, Shanghai, China) was implanted in 19 patients (51.3%), while the Venus A valve (Venus MedTech, Hangzhou, China) was implanted in 18 patients (48.6%). Immediate TAVR procedural and device success rates were 86.5% and 67.6%, respectively, while eight cases (21.6%) required THV-in-THV implantation, and nine cases (24.3%) required permanent pacemaker implantation. Univariate regression analysis revealed that the major factors affecting TAVR device failure were sinotubular junction diameter, THV type, and MDCT anatomical classification (p < 0.05). Compared with the baseline, the left ventricular ejection fraction gradually increased, while the left ventricular end-diastolic diameter remained small, and the N-terminal-pro hormone B-type natriuretic peptide level significantly decreased within one year. Conclusion: According to the results of our study, TAVR with a self-expanding THV is safe and feasible for patients with chronic severe AR, particularly for those who meet the criteria for the appropriate MDCT anatomical classification with intact dual aortic anchors, and it has a significant clinical effect for at least a year. Full article

(This article belongs to the Special Issue Clinical Advances in Surgical or Transcatheter Aortic Valve Replacement)

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