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Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis
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Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis

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

Deadline for manuscript submissions: 31 July 2025 | Viewed by 3342

Special Issue Editor

Dr. Rita Milewski

E-Mail Website
Guest Editor
Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Interests: aortic valve; aortic disease

Special Issue Information

Dear Colleagues,

Aortic stenosis was first described in 1663 by Lazare Riviere with “ossified” aortic stenosis further delineated by Jean Nicolas Corvisart in the late 18th century.

Aortic stenosis is the most common valvular heart disease diagnosed in Western countries.  Patients with a tri-leaflet aortic valve present with calcific aortic stenosis in an older patient population with multiple co-morbidities; however, bicuspid aortic valve disease causes aortic stenosis in a younger population, in which long-term outcomes are especially relevant. Untreated aortic stenosis can progress to heart failure, and subsequent mortality can be high. Unlike other causes of heart failure, no effective medical therapy to prevent or abate aortic stenosis has been identified since it was first described in 1663. As such, aortic valve replacement is the only therapeutic option to impact both the survival and quality of life of these patients. Therefore, it is imperative to identify accurate and innovative methodologies to understand the genetic and acquired etiologies of aortic stenosis. In light of the continually aging population, it is equally as imperative to delineate effective diagnostic and therapeutic strategies to optimize outcomes in all age and economic subpopulations. Models of risk stratification permit timely therapeutic options for both moderate and severe aortic stenosis. This includes clearly defined indications for surgical and transcatheter aortic valve replacement.

The goal of this Special Issue is to highlight novel and innovative approaches to the diagnosis and risk stratification of aortic stenosis to optimize therapeutic strategies including surgical aortic valve replacement (SAVR) and transfemoral aortic valve replacement (TAVR).

Dr. Rita Milewski
Guest Editor

Manuscript Submission Information

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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

  • aortic valve stenosis
  • aortic valve replacement
  • surgical aortic valve replacement
  • transfemoral aortic valve replacement
  • risk stratification for aortic stenosis

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Published Papers (3 papers)

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11 pages, 691 KiB  
Article
Usefulness of Echocardiographic Parameters of Myocardial Work in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation
by Anna Polewczyk, Edward Pietrzyk, Maciej Polewczyk, Dariusz Jarek and Dariusz Dudek
J. Clin. Med. 2025, 14(2), 512; https://doi.org/10.3390/jcm14020512 - 15 Jan 2025
Viewed by 572
Abstract
Background: Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation [...] Read more.
Background: Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods: One hundred and thirty five consecutive patients who underwent TAVI at one center were evaluated before and after the procedure using transthoracic echocardiography (TTE) to assess the following MW indices: global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE). Results: The comparison of MW parameters before and an average of 5.9 days after TAVI showed an increase in GCW, GWW and GWI, and no significant change in GWE. A detailed analysis showed an increase in GCW and GWI only in patients with the worst initial global longitudinal strain (GLS) > −8.0%: 845.2 vs. 852.2; p < 0.001 and 469.7 vs. 499.0 mmHg%; p < 0.001, respectively, whereas in the group of patients with GLS < −16.0%, a reduction in these indices was observed: 2135.8 vs. 2043.0; p < 0.001 and 1732.4 vs. 1633.1 mmHg%; p < 0.001. The significant increase in GWE was observed in patients with left ventricular ejection fraction (LVEF) < 30%: 77.7 vs. 72.0; p = 0.043 and GLS > −8.0%: 74.4 vs. 71.0 mmHg%; p < 0.001. The increase in GCW and GWI parameters after TAVI was strongly correlated with LVEF and pressure aortic gradient (PGA) before the procedure. Conclusions: Echocardiographic assessment of myocardial work parameters is a valuable method of documenting hemodynamic changes in patients with severe aortic stenosis before and after TAVI. Long-term left ventricular overload in patients with aortic stenosis results in a global reduction of myocardial work parameters; therefore, in patients with the lowest LVEF and GLS, the increased GCW, GWI and GWE reflect energy reserves enabling a rapid increase in the effective work of the heart. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis)
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23 pages, 1202 KiB  
Systematic Review
Multiparametric Outcome Assessment After Transcatheter Aortic Valve Implantation—A Systematic Review
by Natalia Świątoniowska-Lonc, Filip Klausa, Krzysztof Ściborski, Agnieszka Wysokińska-Kordybach, Waldemar Banasiak and Adrian Doroszko
J. Clin. Med. 2025, 14(5), 1426; https://doi.org/10.3390/jcm14051426 - 20 Feb 2025
Viewed by 453
Abstract
Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired valvular disorder. Patient risk stratification and the development of an accurate and reliable tool are crucial in identifying suitable candidates for TAVI. The present review summarized the current state of knowledge on the [...] Read more.
Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired valvular disorder. Patient risk stratification and the development of an accurate and reliable tool are crucial in identifying suitable candidates for TAVI. The present review summarized the current state of knowledge on the influence of selected factors on the outcomes and course of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Methods: The inclusion criteria for the present systematic review were as follows: (1) studies indexed in the medical databases PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus; (2) full-text articles available in English; (3) papers published between 2013 and 2023; and (4) addressing the topic of assessing the impact of factors on the outcomes of patients with aortic stenosis undergoing TAVI. This review used PRISMA 2020 reporting guidelines for systematic reviews and meta-analyses. Results: One hundred and thirty-two studies were eligible for this review. The available studies showed an association of psychosocial and socioeconomic factors, valve parameters, comorbidities, clinical factors, treatment-related factors, biomarkers, and treatment methods with the outcomes of patients with AS undergoing TAVI. Conclusions: Given the conflicting results obtained regarding the impact of right ventricular dysfunction, paravalvular leaks, and treatment method on the mortality of patients undergoing aortic valve implantation, further research in these areas is needed. In view of the researchers’ differing views on some of the factors affecting patient outcomes after TAVI, further analysis is needed to develop a new tool for assessing predictive outcomes in AS patients. This study is registered at PROSPERO (CRD42024612752). Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis)
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18 pages, 4604 KiB  
Systematic Review
Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures—A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions
by Sadeq Ali-Hasan-Al-Saegh, Sho Takemoto, Saeed Shafiei, Senol Yavuz, Arian Arjomandi Rad, Lukman Amanov, Ali Saad Merzah, Jawad Salman, Fabio Ius, Tim Kaufeld, Bastian Schmack, Aron-Frederik Popov, Anton Sabashnikov, Arjang Ruhparwar, Alina Zubarevich and Alexander Weymann
J. Clin. Med. 2024, 13(16), 4887; https://doi.org/10.3390/jcm13164887 - 19 Aug 2024
Cited by 1 | Viewed by 1838
Abstract
Background: The management of patients with aortic valve pathologies can sometimes fall into a “gray zone”, where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation [...] Read more.
Background: The management of patients with aortic valve pathologies can sometimes fall into a “gray zone”, where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the “gray zone” of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan–Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the “grey zone” of aortic valve pathologies. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis)
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