Tricuspid valve disease, particularly tricuspid regurgitation, is a highly prevalent condition with complex pathophysiology and long-term adverse consequences. In this Review, Rodés-Cabau and colleagues discuss the latest insights on the natural history and clinical and imaging assessment of tricuspid valve disease, highlighting the surgical management and emerging transcatheter therapies that are transforming clinical practice for this challenging disease.
Valvular heart disease
Advances in our understanding of the mechanisms underlying valvular heart diseases, together with technological innovations and accumulating clinical experience, have led to great improvements in the management of patients with these conditions. This ongoing Series showcases articles from Nature Reviews Cardiology on the latest findings from translational and clinical research covering the entire spectrum of valvular heart diseases, from mitral valve disease and tricuspid valve disease to aortic valve disease and prosthetic valve thrombosis. The articles discuss the advances in the diagnosis and management of these conditions, highlighting current challenges, important considerations for different patient populations and the clinical implications of the latest findings from clinical trials. The Series also includes articles that explore the various aspects of the pathophysiology of valvular heart diseases.
Paravalvular leak (PVL) is a common complication after surgical prosthetic valve implantation. This Review details the role of cardiac imaging in the assessment and management of PVL, summarizes the clinical evidence for percutaneous closure of PVL and compares this procedure with surgical closure.
This Review summarizes the mechanisms of ectopic calcification processes in the cardiovascular system, with an emphasis on emerging knowledge obtained from advances in imaging methods, experimental models and multiomics-generated big data. This Review highlights the potential and challenges of artificial intelligence, machine learning and deep learning to integrate imaging and mechanistic data to identify biomarkers and effective treatments for cardiovascular calcification
This Review highlights the pathophysiology underlying changes in coronary blood flow and the role of functional assessment in patients with high-gradient, high-flow aortic stenosis. Michail and colleagues also discuss factors that influence the immediate and long-term consequences of stenosis treatment.
In this Perspectives article, Rodés-Cabau and colleagues discuss the evolving indications and future applications of transcatheter aortic valve implantation (TAVI). The steady improvement in prosthetic heart valves and the development of novel devices have enabled the continued expansion of TAVI indications, including the use of this procedure in low-risk patients or in aortic pathologies such as pure aortic regurgitation and bicuspid valve disease.
Multivalvular disease is common among patients with valvular disease, and has a complex pathophysiology. In this Review, Unger et al. discuss the mechanisms, diagnosis, and percutaneous and surgical treatment of multivalvular disease, focusing on the combinations of valve pathologies that are most often encountered in clinical practice.
Transcatheter aortic valve implantation (TAVI) is increasingly being used in patients with intermediate-risk and lower-risk profiles, but little is known about the durability of TAVI devices beyond 5 years. In this Review, Arsalan and Walther summarize the existing data on TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and discuss clinical solutions for failed prostheses.
Coronary artery disease (CAD) is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), but its clinical relevance is controversial. In this Review, Danson et al. summarize the methods of assessing CAD in TAVI populations, and the data on the safety and efficacy of percutaneous coronary intervention in patients undergoing TAVI.
News and comments
A number of papers published in 2018 have provided important information expected to influence clinical practice, particularly for the management of functional mitral regurgitation in patients with heart failure caused by ischaemic or non-ischaemic cardiomyopathy and for the treatment of severe aortic stenosis in patients at low surgical risk.
Antithrombotic therapy in 2017: Advances in atherosclerosis, atrial fibrillation, and valvular disease
In 2017, several high-impact studies in thrombosis were published. Refinements were made in the optimal therapy for patients with stable atherosclerosis or with atrial fibrillation undergoing percutaneous coronary intervention. Risk scores to determine duration of antiplatelet therapy were developed. The potential risk of subclinical valve leaflet thrombosis was identified.
A new study reveals a developmental basis for mitral valve prolapse, caused by altered primary cilia-mediated regulation of extracellular matrix deposition during development, and suggests that mutations in primary cilia genes can be the cause of mitral valve prolapse in some patients.
The Evolut Low Risk trial and the PARTNER 3 trial both show that transcatheter aortic valve replacement is at least equivalent to surgery in terms of efficacy and safety for patients with severe aortic stenosis at low operative risk.