Editorial: Reviews in heart valve stenosis and regurgitation

1. IntroductionThis Editorial refers to the research topic “Reviews in Heart Valve Stenosis and Regurgitation”. This research topic collection aimed to assemble high-quality reviews and original articles to highlight recent advances in heart valve disease, whilst emphasizing important directions and new possibilities for future inquiries. We anticipate the collected research will promote discussion in the research community that will translate to best practice applications in clinical, public health, and policy settings. Nine manuscripts were taken into consideration for this research topic, all undergoing a rigorous peer-review process. A total of nine articles were published. The contributions are summarized in the table below:Table 1. Summary.Author Main FindingsValve Replacement Wang et al. Two main research hot topics in research literature: 1) internet-based anticoagulation management models and 2) novel strategies to manage frailty patients.Huang et al. Destroying the aortic anulus increases mortality and health cost management.Transcatheter valves Yu et al. Persistence of cardiac conduction abnormalities in low-risk and younger cohorts remains challenging.Koren et al. Valve degeneration is the main concern in younger patients undergoing TAVR.Hayek et al. Coronary obstruction remains the main challenge in low-risk patients.Rumi et al. Health technologies assessment agencies reached the same recommendations on the use of TAVI despite the differences in clinical and economic domains.Bocchino et al. A multidisciplinary evaluation team is recommended for treating young low-risk patients.Aortic Regurgitation Tang et al. Behcet’s disease patients with severe complications and end-stage heart failure may benefit from TAVR.Risk factors Liu et al. Cardiovascular and cerebrovascular diseases share common risk factors.2. Valve Replacement In patients with valvular heart disease (VHD) therapeutic intervention includes transcatheter and surgical approaches. Valve replacement is indicated as the primary treatment for VHD. However, decision-making can be affected by multiple factors including but not limited to: high risk of heart failure, rehospitalization, risk of reoperation, and various complications that may affect the patient.[1] Furthermore, postoperative management approaches often lead to heterogeneous outcomes.[2] In this research topic collection, Wang et al. performed a bibliometric analysis for the management of patients undergoing valve replacement and its effectiveness in determining prognosis. Bibliometric analysis is mainly used as a tool to understand the state-of-the-art of a specific topic. It also helps to identify “hot” research areas. In this study, Wang et al. aimed to demonstrate a strategy to identify the best management plan, based on high impact published research. The authors identified two main hotspots: 1) the integration of internet-based anticoagulation management models and 2) the need for novel strategies to manage frailty patients. Huang et al. narrowed the attention to infective endocarditis surgical management. This study reported that destroying the aortic annulus increases mortality and health cost management. The latter emphasizes the importance of pre-, peri-, and postoperative management to reduce mortality and morbidity rates in aortic valve endocarditis patients. Early and accurate diagnosis remained the main challenge to address in this cohort. Both studies highlighted the importance of management optimization and the incremental interest in transcatheter aortic valve replacement (TAVR). 3. Transcatheter Valves Transcatheter interventions have become a valuable alternative for the treatment of VHD. It has rapidly been adopted in patients with severe aortic stenosis (AS). The constant upgrade in transcatheter valve design, surgical safety, and reduction of complication rates and perioperative mortality have increased its treatment adaptation.[3] However, challenges exist in the incidence of cardiac conduction abnormalities after TAVR procedures. Yu et al. reviews the latest mechanisms, predictors, and types of conduction abnormalities after transcatheter aortic valve replacement TAVR. The authors emphasize the challenge derived from the persistence of cardiac conduction abnormalities for the broader application in low-risk and younger cohorts. A comprehensive preoperative, perioperative, and postprocedural assessment is suggested including anatomical, electrophysiologic, and surgical risk factors. A critical aspect of TAVR implantation is valve mal-deployment, which may lead to an increased risk of thrombus formation.[4] Koren et al. provide an overview of the mechanisms, prevention strategies, and treatment for leaflet thrombosis in TAVR. Several factors could cause thrombosis on the valve leaflets, recent studies suggest that blood flow shear forces can be implicated in promoting the thrombosis cascade.[5] Prevention measures are suggested for high-risk patients by intensifying antithrombotic therapy. The use of TAVR in low-risk patients has increased with positive outcomes in comparison to surgical approaches.[6,7] The main concern of younger patients undergoing TAVR is valve degeneration over time. Valve-in-Valve concept has been proposed as a solution. Hayek et al. reviews this approach, which involves comprehensive management and surveillance of coronary obstruction, and stroke prevention. Primarily, the goal is to define lifetime management for the likelihood of further interventions. As the use of TAVR in elderly patients has been well adapted and established, its use has been extended to low-risk patients such as symptomatic severe aortic stenosis. Rumi et al. aimed to analyze the diverse methods and interpretation of outcomes and their limitations. Authors reported a certain degree of heterogeneity in current recommendations, assessment, development, and evaluation. The financial evaluation favors the cost-effectiveness of TAVR compared with surgical aortic valve replacement. Bocchino et al. aimed to revise the adaptation of TAVR in younger patients. The authors highlighted the need to change the decision-making process in the treatment of VHD and the multidisciplinary evaluation supported by a specialized team treating young low-risk patients. 4. Aortic Regurgitation Another important consideration in patients with aortic stenosis is the development of aortic regurgitation. Behcet’s disease has a high postoperative complication rate and mortality. Severe regurgitation patients often present perivalvular leakage, pseudoaneurysm, and poor long-term prognosis. Tang et al. aimed to summarize the evolution of surgical techniques for Behcet’s disease and its symptoms leading to aortic regurgitation.[8,9] Authors pointed out that patients with severe complications and end-stage heart failure may benefit from TAVR. However, it is recognized that more evidence is needed to define adequate surgical management. 3. Risk Factors Finally, Liu et al. reviews the risk factors related to intracranial and extracranial arteries, and coronary stenosis. These contributions support contextualizing the close interaction between cardiovascular and cerebrovascular diseases considering most common risk factors. Acknowledgements This research topic would not be possible without the contribution of enthusiastic and talented authors. I would like to express my great gratitude to all the reviewers. Your extraordinary feedback allowed the authors to improve their manuscripts and sustain the high-quality peer review standards.Conflicts of Interest: The authors declare no conflicts of interest.

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