Aortic Valve Stenosis and Aortic Regurgitation: Recent Insights, Current Challenges, and Future Prospects

Dear Colleagues,

Disease of the aortic valve is a common pathology. Aortic valve stenosis typically presents in the seventh to eighth decades of a person’s life, and is a typical disease of the elderly patient. Congenitally bicuspid valves can lead to premature calcification. Rheumatic fever has become a rare cause in industrialized countries but is still present in developing countries. Aortic valve regurgitation is attributable to similar causes but may typically occur acutely in endocarditis or aortic dissection. Both valve defects can lead to pressure and volume overload of the left ventricle, ultimately resulting in irreversible heart failure. Therefore, the optimal time for surgical or interventional therapy must not be missed.

The introduction of extracorporeal circulation by Gibbon in 1953 paved the way for today’s open-heart valve surgery. Since the 1960s, various designs of mechanical valve prostheses have been developed, of which the double-leaflet prosthesis is essentially what remains. However, their use is constantly decreasing due to the mandatory life-long anticoagulation. Development of biological valve prostheses also began in the sixties. After the surgical use of frozen homografts and pulmonary autografts by Donald Ross, numerous porcine and bovine valve prostheses were developed owing to the introduction of chemical preservation procedures. These biological valves play a dominant role today as they do not require anticoagulation. However, they are subject to valve degeneration.

Interventional cardiology has now also found its destiny in the transvascular implantation of catheter valves. The first TAVI was successfully implanted by Alain Cribier in 2002. Since then, development of various designs of catheter-based valves has begun in this field. In response, sutureless and rapid-deployment valves have been introduced in cardiac surgery, minimally invasive procedures have been further promoted, and repair procedures have been enhanced. Surgical and interventional approaches each have their specific advantages and disadvantages, so that today the optimal therapy is specified by the heart team, taking into account the patient's preferences.

The scope of this Special Issue encompasses both interventional and surgical valve therapy, including indications, technical strategies, clinical outcomes, new devices, or research technologies such as 3D printing. In addition, anatomical and physiological aspects, such as valvular hemodynamics or patient-prosthesis mismatch, are covered as well as the latest findings from diagnostics and imaging. Medical strategies such as heart failure therapy or anticoagulation after valve replacement are also considered; not to forget special conditions such as endocarditis, frailty, or redo surgery.

This Special Issue is dedicated to the scientific discourse on the topic of aortic valves and is intended to stimulate lively discussions on the best strategies for the benefit of the patient. I wish the venture much success.

Dr. Martin Hartrumpf
Dr. Gesine Dörr
Guest Editors

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• aortic valve
• surgical valve replacement
• transcatheter valves
• TAVI
• valve pathology
• diagnostics
• echocardiography
• imaging
• artificial valves