Abstract
The Journal of the Heart Valve Society (JHVS) is an international, peer-reviewed journal publishing high-quality, original research and innovations on the etiology, pathophysiology, diagnosis, prevention, and treatment of heart valve disease (HVD). This is the only journal fully dedicated to HVD. The journal is the flagship of the Heart Valve Society and provides a voice and forum to the research and healthcare community involved in the management of HVD and to the people living with HVD. The first inaugural issue focused on aortic valve stenosis and was published in February 2025 and is available at the following link: https://journals.sagepub.com/toc/HVS/current
We also recently published a supplemental issue featuring the abstracts presented at the 2024 Heart Valve Society Meeting (Boston), which can be accessed using this link: https://journals.sagepub.com/toc/hvsa/2/1_suppl
Today, I am pleased and proud to present the second issue of the JHVS, which is focused on valve interventions and devices. Indeed, until today, no pharmacotherapy has been proven to be able to slow or halt the progression of HVD, and the only available option to treat severe HVD is to perform a surgical or transcatheter valve intervention to repair or replace the failing valve. Since the first mitral valve repair surgery in 1923, and the first valve replacement by a ball-caged mechanical valve in 1953, a tremendous amount of progress has been accomplished in the field of valve interventions. The introduction of transcatheter valve therapies, and particularly transcatheter aortic valve implantation (TAVI), has triggered major innovations and has paved the way to multiple new procedures and devices to treat HVD in a less invasive manner. In this context, the second issue of the JHVS, which is fully dedicated to procedures and devices for repair or replacement of heart valves, is important and timely. This issue includes 7 original articles and 3 state-of-the-art review articles on this topic, which are briefly described below:
Langenaeken, Van Hecke, Meuris, et al. from the University Hospitals Leuven, Belgium, performed an elegant experimental study comparing the thrombogenicity of the sheep model compared to the pig model of pulmonary valve replacement. Indeed, recent studies have questioned the validity of the sheep as the model of choice for the evaluation of mechanical heart valves. The investigators found that the sheep model is not thrombogenic enough to elicit mechanical valve thrombosis in the pulmonary position, which is generally highly thrombogenic. On the other hand, the porcine model rapidly elicits massive valve thrombosis. These findings confirm that the pig model should become the new standard for mechanical valve thrombosis research.
McMahon, Prunty, Syedain, et al. from the University of Minnesota, USA, report the results of a study that is one of the first to demonstrate the long-term in vivo performance of an allogenic, decellularized, bioengineered tissue valve in the juvenile sheep model. Furthermore, in a high-cycle fatigue stress tester, the bioengineered valve showed no evidence of structural or functional deterioration after 75 million cycles. The results of this study suggest that bioengineered tissue valves could provide a valuable alternative to bioprosthetic valves, especially in the younger patients in whom the structural and functional durability of the valve substitute is critical.
Vogl, Vitale, Hatoum, et al. from the Michigan Technological University, USA, Mayo Clinic, USA, Universita degli Studi di Milano, Italy, report the results of a retrospective analysis comparing 52 patients who underwent TAVI and compared the anatomical characteristics of the aortic arch in patients who had stroke following TAVI (n = 26) versus those who did not (n = 26). Patient-specific 3D digital models of the ascending aorta, aortic arch, and calcium were created for each patient. The investigators found that aortic arch cross-sectional area ratio (cerebral ostia cross-sectional areas/arch cross-sectional area) and bovine arch configuration were the most significant correlates of stroke after TAVI. These findings may help to identify, prior to the TAVI procedure, the patients who are at higher risk of stroke and who may thus benefit from concomitant preventive procedures such as the use of cerebral protection devices.
Allaham, Al Najar, and Allahan et al from the Albasheer Hospital for Specialized Surgery, Jordan, LSI Solutions, USA, and University of Rochester Medical Center, USA, present a single-center experience using titanium fasteners (TF) in 100 patients undergoing single, double, or triple valve replacement surgery through a median sternotomy approach, compared to the experience in 100 patients using hand-tied knots for the sutures. Patients whose valve sutures were secured with TFs experienced significantly shorter cardiopulmonary bypass time and aortic-cross clamp time. In open heart surgery, “time is trauma” and any improvement in the surgical technique that allows the surgeon to shorten the time of the procedure is valuable and may improve patient outcomes.
Calin, Cartier, Forcillo, et al. from the University of Montréal and the Université Laval, Canada, report the incidence of prosthesis-patient mismatch (PPM), the hemodynamic performance, as well as the clinical outcomes of the Carpentier-Edwards Magna Ease bioprosthesis in the aortic position, while addressing sex-based disparities and variations in valve size in a series of 1062 patients. The incidence of overall PPM was much higher in women (45%) than in men (18%) but was not associated with increased risk of mortality at 5 years. This study emphasizes that women are at high risk of severe PPM essentially because they have a smaller aortic annulus and thus a particular effort should be made to implement preventive strategies to avoid severe PPM in women undergoing aortic valve replacement.
Lamberigts, Sarrazin, Meuris, et al. from KU Leuven, Belgium, and University Hospital of Liège, Belgium, report the results of a single-center experience of 1136 consecutive patients who underwent aortic valve replacement with a sutureless bioprosthetic valve. In-hospital mortality was 3.4% and long-term outcomes were excellent with low incidence rates of endocarditis (0.5%) and severe structural valve deterioration (0.7%) at 10 years. There was, however, an important survivorship bias given that the average age of the patients at the time of surgery was 79 years old and only 25% were still alive at the 10-year follow up. This study, which represents one of the largest series in terms of number of patient-years follow up with a sutureless valve, shows favorable early and late outcomes and long-term durability.
Torky, Lamberigts, Meuris, et al. from Tanta University Faculty of Medicine, Egypt, and KU Leuven, Belgium, report the results of a retrospective analysis in which they compared 95 patients (average age 56 years old) with an Inspiris bioprosthetic valve with 69 patients receiving a bileaflet mechanical valve and also performed a propensity score matched comparison with 40 patients in each group. Patients in the Inspiris group had a lower incidence of bleeding (2.5% vs 12.5%) and thrombo-embolism (2.5 vs 5.0%) during follow up. These findings suggest that the Inspiris valve could be a good alternative to the mechanical valves for aortic valve replacement in the younger population. Further studies with longer follow up are necessary to examine the long-term durability of the Inspiris valve in this young population.
“If you fail to plan, you are planning to fail” Benjamin Franklin. Becker, Clark, Dasi, et al. from the Ohio State University, USA, Baylor Scott and White Heart Hospital, and Emory University, USA, present a review article that explores the impact of computational modeling on aortic root replacement, which is a complex and invasive procedure often performed concomitantly to other aortic interventions. In this review, the authors examine 2 scenarios: The first scenario involves using computational modeling to predict patient-specific outcomes for additional structural interventions following aortic root replacement. The second scenario focuses on simulating and planning aortic root replacements performed in conjunction with aortic valve repair. By simulating various surgical techniques, these models optimize procedure planning, effectiveness, safety, and the reproducibility of high-quality clinical outcomes.
“The only valve that I don’t repair is the one that I don’t understand” Dr Tirone David. Aortic valve repair has been shown to reduce valve-related mortality, while restoring life quality and longevity similar to that of the general population. However, the rate of adoption of aortic valve repair worldwide remains low (around 15%-20%), although 80% of regurgitant valves could be repaired. In this issue of the JHVS, Lansac and Youssefi, from Hôpital de la Pitié Salpetrière, France, and Royal Brompton and Harefield Hospitals, UK, present a comprehensive and superbly illustrated state-of-the-art review on aortic valve repair. After reading this review article, there are probably very few valves left that you would no longer understand.
Sallé, Guimbretière, Capoulade et al. from Nantes University, France, Padua University, Italy, and Tel Aviv University, Israel present a state-of-the art article providing new insights into the pathophysiology of structural degeneration of bioprosthetic valves. In particular, the authors provide an overview of the relevant studies assessing the role of (i) the biomaterial structure and manufacturing processes, (ii) the active cell-mediated fibrocalcific processes, (iii) the residual immunogenicity of the current animal-derived biomaterial, and (iv) the subclinical thrombosis, in the development and progression of structural valve deterioration. This is certainly one of the best review articles that has been published on this important and timely topic.
I am convinced that you will enjoy and learn a lot by reading this second issue of the JHVS that we are publishing today. The third issue of JHVS, to be released in July 2025, will focus on mitral and tricuspid valve disease. The fourth issue, scheduled for September 2025, will address topics related to diversity, equity, and inclusion, as well as underrepresented and underserved populations in HVD. We are also planning to dedicate a full issue of the JHVS to the important topic of rheumatic heart valve disease. Following the 2025 Heart Valve Society meeting in Cairo, Egypt, in April 2025, we will publish a supplemental issue featuring the abstracts presented at this meeting. The authors and presenters of these abstracts are also strongly encouraged to submit a full article to the JHVS. We will ensure a fast and high-quality review process, as well as rapid online publication following acceptance of these articles.
I also strongly encourage you and your colleagues to support the JHVS by submitting your best articles to the journal, citing its publications, and sharing them on social media.
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