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Heart Valve Disease: Recent Advances in Therapeutic Approaches
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Heart Valve Disease: Recent Advances in Therapeutic Approaches

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 (14 June 2024) | Viewed by 4063

Special Issue Editor

Prof. Dr. Evaldas Girdauskas

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
Interests: heart valve disease; stenosis; regurgitation; prolapse; transcatheteraortic valve implantation; balloon valvuloplasty

Special Issue Information

Dear Colleagues,

As the population ages, heart valve disease becomes a growing health problem worldwide. Heart valves, including the aortic valve, mitral valve, pulmonary valve and tricuspid valve, control the direction of your blood flow. Heart valve disease is a common condition that one or more of the valves do not open or close properly. The causes are often linked to birth defects, age or other conditions. In the past, medication and open-heart surgery are the common treatments for heart valve diseases. However, with the advances in medical technology, a range of innovative, minimally invasive procedures are developed, such as transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair (MitraClip) and robotic mitral valve repair.

This Special Issue aims to collate state-of-the-art research on heart valve disease. Original articles, reviews, and communications are welcome. We look forward to receiving your contributions.

Prof. Dr. Evaldas Girdauskas
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

  • heart valve disease
  • stenosis
  • regurgitation
  • prolapse
  • transcatheter
  • aortic valve implantation
  • balloon valvuloplasty

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Published Papers (3 papers)

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Research

15 pages, 4245 KiB  
Article
Non-Invasive Ultrasound Therapy for Severe Aortic Stenosis: Early Effects on the Valve, Ventricle, and Cardiac Biomarkers (A Case Series)
by Danijela Trifunović-Zamaklar, Radmila Karan, Nataša Kovačević-Kostić, Duško Terzić, Vladimir Milićević, Olga Petrović, Ivana Canić, Mathieu Pernot, Mickael Tanter, Louise Z. Wang, Guillaume Goudot, Miloš Velinović and Emmanuel Messas
J. Clin. Med. 2024, 13(16), 4607; https://doi.org/10.3390/jcm13164607 - 7 Aug 2024
Viewed by 1561
Abstract
Background: Transcatheter aortic valve replacement (TAVR) was developed for inoperable patients with severe aortic stenosis. However, despite TAVR advancements, some patients remain untreated due to complex comorbidities, necessitating less-invasive approaches. Non-invasive ultrasound therapy (NIUT), a new treatment modality, has the potential to [...] Read more.
Background: Transcatheter aortic valve replacement (TAVR) was developed for inoperable patients with severe aortic stenosis. However, despite TAVR advancements, some patients remain untreated due to complex comorbidities, necessitating less-invasive approaches. Non-invasive ultrasound therapy (NIUT), a new treatment modality, has the potential to address this treatment gap, delivering short ultrasound pulses that create cavitation bubble clouds, aimed at softening embedded calcification in stiffened valve tissue. Methods: In the prospective Valvosoft® Serbian first-in-human study, we assessed the safety and efficacy of NIUT and its impact on aortic valve hemodynamics, on the left ventricle, and on systemic inflammation in patients with severe symptomatic aortic stenosis not eligible for TAVR or surgery. Results: Ten patients were included. Significant improvements were observed in hemodynamic parameters from baseline to one month, including a 39% increase in the aortic valve area (from 0.5 cm2 to 0.7 cm2, p = 0.001) and a 23% decrease in the mean transvalvular gradient (from 54 mmHg to 38 mmHg, p = 0.01). Additionally, left ventricular global longitudinal strain significantly rose, while global wasted work significantly declined at one month. A dose–response relationship was observed between treatment parameters (peak acoustic power, intensity spatial-peak pulse-average, and mean acoustic energy) and hemodynamic outcomes. NIUT was safely applied, with no clinically relevant changes in high-sensitivity troponin T or C-reactive protein and with a numerical, but not statistically significant, reduction in brain natriuretic peptide (from 471 pg/mL at baseline to 251 pg/mL at one month). Conclusions: This first-in-human study demonstrates that NIUT is safe and confers statistically significant hemodynamic benefits both on the valve and ventricle. Full article
(This article belongs to the Special Issue Heart Valve Disease: Recent Advances in Therapeutic Approaches)
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13 pages, 741 KiB  
Article
Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes
by Philipp Schnackenburg, Shekhar Saha, Ahmad Ali, Konstanze Maria Horke, Joscha Buech, Christoph S. Mueller, Sebastian Sadoni, Martin Orban, Rainer Kaiser, Philipp Maximilian Doldi, Konstantinos Rizas, Steffen Massberg, Christian Hagl and Dominik Joskowiak
J. Clin. Med. 2024, 13(15), 4461; https://doi.org/10.3390/jcm13154461 - 30 Jul 2024
Viewed by 1095
Abstract
Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who [...] Read more.
Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th–75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Results: Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5–8.5) in the Redo-SAVR group and 9.2% (5.4–13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group (p < 0.001; p < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10–30) vs. 26 mmHg (19–38), p < 0.001) (9 mmHg (6–15) vs. 15 mmHg (9–21), p < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group (p = 0.013). VARC-3 Early Safety were comparable between the two populations (p = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020–1.104], p = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160–6.048], p = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160–6.048], p = 0.021) showed a significant correlation to ViV-TAVR. Conclusions: Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses. Full article
(This article belongs to the Special Issue Heart Valve Disease: Recent Advances in Therapeutic Approaches)
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12 pages, 1727 KiB  
Article
Bicuspid Morphology and Rapid Deployment Valve Replacement: Is This Still a Contraindication?
by Julia von der Linden, Florian Herrmann, Sergey Belyaev, Gerd Juchem, Sven Peterss, Christian Hagl and Alexey Dashkevich
J. Clin. Med. 2023, 12(23), 7390; https://doi.org/10.3390/jcm12237390 - 29 Nov 2023
Viewed by 978
Abstract
When using rapid deployment surgical aortic valve replacement (RD SAVR) in treating bicuspid aortic valve morphology (BAV), several challenges are faced due to annular asymmetry. The Sievers classification has been traditionally used for the description of BAV morphology. In this study, we aimed [...] Read more.
When using rapid deployment surgical aortic valve replacement (RD SAVR) in treating bicuspid aortic valve morphology (BAV), several challenges are faced due to annular asymmetry. The Sievers classification has been traditionally used for the description of BAV morphology. In this study, we aimed to conduct a retrospective feasibility analysis of RD SAVR in relation to the Sievers classification. From January 2014 to March 2022, 31 patients with BAV morphology (15 patients with Sievers type 0 BAV and 16 with Sievers type 1 BAV) underwent RD SAVR. Specific surgical techniques were applied depending on the BAV morphology. Comparable clinical outcomes were observed. No paravalvular leaks and no valvular re-interventions occurred in either group. CPB and cross-clamping times, as well as the prosthesis sizes used, were also not significantly different. Postoperative mean gradients were comparable in both groups. No significant distinction was found between the groups in terms of postoperative pacemaker indication, postoperative stroke, or death. Annular symmetry can be adequately restored through precise prosthesis sizing and placement according to an individual’s valve morphology regardless of the Sievers classification of BAV by choosing a different landmark for the initial suture. RD SAVR seems to be a safe approach for any bicuspid morphology, with good hemodynamic results and time-saving potential in experienced hands. Full article
(This article belongs to the Special Issue Heart Valve Disease: Recent Advances in Therapeutic Approaches)
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