Series |

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.

Reviews

Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. In this Review, Prendergast and colleagues discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

Review Article | | Nature Reviews Cardiology

Next-generation tissue-engineered heart valves (TEHVs) are a promising therapeutic option for patients with valvular heart disease. In this Review, Emmert and colleagues discuss the current heart valve replacement options, describe the design of TEHVs and summarize the data from preclinical and clinical studies on the use of TEHVs.

Review Article | | Nature Reviews Cardiology

In this Review, Alfieri and colleagues focus on new concepts on mitral valve pathophysiology and patient risk profile assessment to guide the indication and timing of the management of mitral valve regurgitation. The authors also describe new imaging modalities and contemporary surgical and transcatheter techniques, highlighting the need for a multidisciplinary approach.

Review Article | | Nature Reviews Cardiology

This Review discusses the evolving indications of transcatheter aortic valve implantation (TAVI), including the latest clinical trials in young and low-risk patients with symptomatic severe aortic stenosis and ongoing studies exploring TAVI for other indications, including severe bicuspid aortic valve stenosis and pure native aortic regurgitation, highlighting procedural implications and caveats of new and future indications.

Review Article | | Nature Reviews Cardiology

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.

Review Article | | Nature Reviews Cardiology

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.

Review Article | | Nature Reviews Cardiology

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

Review Article | | Nature Reviews Cardiology

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.

Opinion | | Nature Reviews Cardiology

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.

Review Article | | Nature Reviews Cardiology

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.

Review Article | | Nature Reviews Cardiology

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.

Review Article | | Nature Reviews Cardiology

News & Comment

Surgical mitral valve repair produces exceptional long-term survival, durable relief from mitral regurgitation, and physiological valve performance. Percutaneous mitral valve repair might prohibit subsequent surgical reconstruction. This finding has important implications, including for patient consent and clinical trial design. The objectives of mitral valve intervention must focus on life expectancy and long-term valve function.

News & Views | | Nature Reviews Cardiology

Valve replacement is currently the only treatment for calcific aortic valve disease. Studies of an uncommon, genetic form of aortic valve disease have yielded in vitro and mouse models of the disease and a transcriptomic disease signature. Machine learning-driven screens for compounds that normalize this signature promise to enable medical management of aortic valve disease.

News & Views | | Nature Reviews Cardiology

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.

Year in Review | | Nature Reviews Cardiology

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.

Year in Review | | Nature Reviews Cardiology

The combination of oral anticoagulation and the antiplatelet drug clopidogrel increases the risk of bleeding after transcatheter aortic valve implantation (TAVI) compared with oral anticoagulation alone, according to the results of the POPular TAVI trial cohort B.

Research Highlight | | Nature Reviews Cardiology

The 2-year results of the MITRA-FR trial confirm the 1-year findings showing that addition of percutaneous mitral valve repair to medical treatment does not reduce the risk of death or hospitalization for heart failure compared with medical treatment alone in patients with heart failure and severe secondary mitral regurgitation

Research Highlight | | Nature Reviews Cardiology

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.

Research Highlight | | Nature Reviews Cardiology

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.

Research Highlight | | Nature Reviews Cardiology