Dear Colleagues,

The treatment of aortic valve pathologies has undergone important changes in recent years. Open cardiac surgery has been giving way to less aggressive techniques, including transcatheter or surgeries with a minimally invasive approach and with the intention of preserving the aortic valve in cases of valve regurgitation. These new techniques have managed to improve the clinical results of patients and reduce the risk of complications. All of these modern techniques require prior in-depth research that includes several imaging techniques, such as transesophageal echocardiography, multidetector cardiac tomography or cardiac magnetic resonance. The intention of this Special Issue is to showcase state-of-the-art techniques for aortic valve repair and replacement as well as the imaging techniques required for the correct planning of these procedures.

Dr. Jose Alberto De Agustín
Guest Editor

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• aortic valve pathologies
• minimally invasive approach
• aortic valve repair
• aortic valve replacement
• imaging techniques

Title: Aortic stenosis and the evolution of cardiac damage after transcatheter aortic valve replacement.
 
Abstract: Introduction. Severe aortic stenosis is the most frequent valvular heart disease in an increasingly older population [1,2]. Different models for stratifying cardiac damage associated with aortic stenosis have been developed [3-4] to predict mortality following valve replacement, whether surgical or percutaneous. The aim of this study is to provide morphological and functional data of cardiac damage and its relationship with outcomes in patients undergoing TAVR. Methods. Transthoracic echocardiograms (TTE) before the intervention and at one-year follow-up, were performed according to current guidelines [6] and were conducted and/or supervised by experts in cardiovascular imaging. Patients were classified according to a cardiac damage system previously described [5] as follows: Stage 0, no cardiac damage: left ventricle global longitudinal strain (LV-GLS) < -17.5%; right ventricular-arterial coupling (RVAc) ≥ 0.35,) and absence of significant MR. Stage 1, left-sided subclinical damage: LV-GLS ≥ -17.5%. Stage 2, left-sided damage: significant MR. Stage 3, right-sided damage: RVAc < 0.35. Clinical data were obtained from clinical records. Data and events of patients were included in a prospective registry and subsequently analysed. Categorical data are presented as frequencies and percentages and compared using the χ2 test or Fisher’s exact test. Continuous variables were expressed as mean ± standard deviation (SD) and were compared using the Students’ T-test and the Mann-Whitney U test as necessary. Assessment for the normality of data was performed using the Shapiro-Wilk test. Results. 496 patients were included in the analysis after excluding those with incomplete data and those who underwent valve-in-valve TAVR. Mean age was 82.1±5.9 years, 53.0% were female and hypertension was the most frequent risk factor 81.5%. There were no significant differences among groups regarding to age and gender. Chronic kidney disease was significantly more prevalent in patients with any degree of cardiac damage (p= 0.017). Patients with cardiac damage showed larger left ventricular end-diastolic volume (LVEDV) (P= 0.002), LV mass (p= <0.001) and left atrial volume index (LAVI) (p= <0.001); E/e’ ratio and pulmonary artery systolic pressure (PSAP) were significantly higher among these patients (p= <0.001). As for LV ejection fraction (LVEF) and global longitudinal strain (GLS), patients with cardiac damage showed significantly lower values (p= <0.001). After one year of follow-up, patients classified as having some degree of myocardial damage, persisted with higher LVEDV, LV mass and LAVI compared to the group without cardiac damage, although not statistically significant. E/e’ ratio remained higher in these patients (p= 0.284). LVEF and GLS were both lower in patients with cardiac damage (p= 0.005 and p= <0.001) at follow-up. Patients with cardiac damage had hierarchically higher mortality relative to the group without cardiac damage (p= 0.004). Conclusions. Cardiac damage secondary to severe aortic stenosis has morphological and functional repercussions that even after valve replacement persist and might worsen the prognosis.