Abstract
On behalf of the editorial board, I am pleased and proud to introduce the fourth issue in the life of the Journal of the Heart Valve Society (HVS), which is actually the third and last issue of Volume 2 published in 2025. This issue primarily focuses on the disparities and inequities in the management of heart valve disease (HVD). Access to screening, diagnosis, and treatment of HVD varies extensively depending on age, sex, race, socio-economic status, countries, geographical location (rural vs urban). Indeed, several subsets of the population are underserved and undertreated, and in particular elderly people, women, pediatric population, people with low socio-economic status, racial minorities, First Nations people, people living in low- and middle-income countries (LMICs). These subsets are also under-represented in clinical trials and in research studies in general, therefore leading to a lack of data to guide the management of HVD in these underserved / underrepresented populations. Rheumatic heart disease (RHD) is a major cause of HVD, particularly in LMICs. RHD is responsible for 370,000 deaths per year, and most of the deaths are in teenagers and young adults.
The time has come to collectively and strongly act to eliminate these major disparities and inequities in HVD care. The HVS and its journal are actively engaged in this fight. The current issue of the JHVS, which is a first important battle in this fight, presents: 6 original articles, 2 review articles, 1 viewpoint, and 1 community forum article.
In an original research article, Viana Gerbier, Julien Magne, Victor Aboyans from the University of Limoges, France, Bernard Lung from Hôpitaux de Paris, Abdoul Kane from Grand Yoff General Hospital, Dakar, Sénégal, Léopold Codjo from National University Hospital Hubert Koutoukou Maga, Cotonou, Benin, and Christophe Konin from Institute of Cardiology, Abidjan, Côte d’Ivoire, present the epidemiological trends in rheumatic and non-rheumatic HVDs in LMICs in the 1990 to 2019 period. The authors observed that the average prevalence of rheumatic HVD has declined over the years but remains high in many LMICs. In the meantime, the prevalence of non-rheumatic HVD has increased in these countries. Hence, LMICs are now confronted to a double burden. These findings further emphasize the urgent need to intensify research and public health strategies in LMICs. This article is accompanied by a thoughtful editorial by Susy Kotit from Aswan Heart Centre in Egypt. The main take-home message of this editorial is that: “The global challenge of HVD demands a nuanced, dual-focused approach that simultaneously addresses the enduring scourge of rheumatic HVD and the rising tide of non-rheumatic HVD, especially in LMICs.”
In a viewpoint article, Julien Magne and Victor Aboyans from Université of Limoges, Abdoul Kane from Grand Yoff General Hospital, Dakar, Sénégal, and Léopold Codjo from National University Hospital Hubert Koutoukou Maga, Cotonou, Benin present an important perspective that builds on the aforementioned original research article. They emphasize the point that HVD in LMICs is characterized by a dual burden of rheumatic and degenerative etiologies, reflecting a global epidemiological transition in these countries. Despite increasing prevalence and severity, HVD remains markedly under-researched in these countries, leading to diagnostic and therapeutic inequities. The authors emphasize that strategic investment in epidemiological mapping, etiological profiling, economic evaluation, and implementation science is essential to guide action.
In an elegant original research article, Lucy Nam, Dane Paneitz, and Jordan Bloom from Massachusetts General Hospital, USA, and Michael Ibrahim (Penn Presbyterian Medical Center, Philadelphia, USA), Christopher Burke (University of Washington Medicine Heart Institute, Seattle, USA), Maral Ouzounian (Toronto General Hospital, Toronto, Ontario, Canada), Michael Chu (Western University, London, Ontario, Canada), Darryl Shore (Royal Brompton Hospital, London, England), and Ismail El-Hamamsy (Sinai Icahn School of Medicine, New York, USA) report the results of an international survey on the Ross procedure practices. This survey highlights wide variability in practices, underscoring the need for standardized training and protocols for this complex procedure. This article was highlighted in an excellent editorial by Maximiliaan Notenboom, Kevin Veen, Yannick Taverne, and Johanna Takkenberg from the Department of Cardiothoracic Surgery, Erasmus, Rotterdam, The Netherlands. In this editorial entitled “Global Momentum for the Ross Procedure: Now is the Time,” the authors emphasize that the cardiac surgery community is again at crossroads with the Ross procedure. With status quo, the Ross procedure will continue as a niche solution. If, on the other hand, the cardiac surgery community expands educational and data sharing frameworks, a much broader group of patients could benefit from this procedure in the future.
In this issue, we also feature an interesting research study by Abdul Hakeem and colleagues from National Institute of Cardiovascular Diseases, Aga Khan University Hospital, and Tabba Heart Institute, Karachi, Pakistan, which reveals that the Pakistani population exhibits a higher incidence of smaller sinus of Valsalva (SOV) dimensions compared to the European population and a higher incidence of shorter coronary artery heights. These findings suggest that the Pakistani patients may be at higher risk of coronary obstruction during the TAVR procedure and underline the need for tailored TAVR device designs and procedural strategies for this population. In an elegant editorial, Silvia Mas-Peiro from Goethe University in Frankfurt, Germany, advocates for the need of geographically-tailored TAVR designs and procedures.
Gianluigi Perri and colleagues from Bambino Gesù Children Hospital IRCCS, Rome, Italy, report the mid-term results of a new heart valve tissue bioprosthesis (Inspiris Resilia Valve; IRV) for pulmonary valve replacement. This study raises concerns on the durability of this bioprosthetic valve when implanted in the pulmonary position in children. This article was accompanied by an insightful editorial by Jessica Forcillo from the Centre Hospitalier de l’Université de Montréal, Canada, in which she emphasizes the need for further research to study the long-term outcomes of this bioprosthetic valve in the pulmonary position and the mechanisms of failure.
In an original research article, Katell Delanoë, Vikoria Stanovà and colleagues from Institut universitaire de cardiologie et de pneumologie de Québec—Université Laval, Québec, Canada compare the hemodynamic performance of 2 models of mitral bioprosthetic valves in a cardiac mock flow model. This in vitro study reveals that the bovine bioprosthetic valve has superior hemodynamics and causes less prosthesis-patient mismatch compared to the porcine valve. This article is accompanied by a fascinating editorial by Anne-Sophie Zenses who underlines that hemodynamic performance is crucial for preventing prosthesis-patient mismatch and improving patient outcomes, but does not necessarily guarantee long-term valve durability.
Monisha Srabanti, Julio Garcia et al from Libin Cardiovascular Institute of Alberta, Calgary, Canada, and Lyes Kadem from Concordia University, Montreal present a fascinating research study in which, using 4D Flow cardiac magnetic resonance imaging (MRI), they demonstrate that mitral regurgitation affects early diastolic filling and peak systolic ejection, therefore providing insights into dynamic flow patterns and LV remodeling. These analyses could enhance risk stratification and guide therapeutic decisions, complementing traditional diagnostic methods for improved management of mitral regurgitation. In a very interesting editorial, Mickael Markl from Northwestern University Feinberg School of Medicine, Chicago, USA concludes that this study represents an important step forward in the functional assessment of mitral regurgitation and exemplifies how advances in imaging technology such as 4D flow MRI can reshape our understanding of cardiovascular disease.
In this issue of the journal, we also feature a state-of-the-art review article by Kathia Abdoun, Paolo Springhetti, Andréanne Powers, and Marie-Annick Clavel from Institut universitaire de cardiologie et de pneumologie de Québec—Université Laval, which provides a comprehensive overview of the current knowledge and challenges related to sex-differences and specifics in the clinical presentation, management strategies, and therapeutic responses in women with HVD. This article provides a strong impetus to implement strategies tailored to women in order to enhance their valvular health.
This issue also presents an outstanding review article on IT-based solutions to address disparities in HVD care by Seyed Mohammad Forouzannia, Michela Faggioni, Lucas Zier, and Sammy Elmariah from University of California at San Francisco, USA. This review is very timely and reveals that IT and Artificial Intelligence tools are ready for prime time and can help to considerably reduce the disparities in HVD care, especially in women.
Finally, Daniel Chaparro et al from the Young Professional Network (YPN) from the HVS, report that the activities and developments of the YPN over the past year demonstrated continued progress toward its mission of fostering a collaborative and interdisciplinary community for early career. The YPN has been very successful and productive since its launch 1 year ago and I strongly encourage the members of HVS who are in their early career to join and contribute to the YPN.
I anticipate that you will enjoy and learn a lot by reading this spectacular issue that we are publishing today on such an important and timely topic: that is, One World: Many Heart Valve Voices. In the future, we will always welcome any submission of original research, review, or viewpoint articles on this topic.