Transcatheter aortic valve replacement:A journey of two decades and beyond

The number of patients with calcic aortic stenosis(AS)is 9.4 million according to 2019 Global Disease Burden estimates,which will continue to increase as the population ages.[1]For the treatment of symptomatic severe AS,transcatheter aortic valve replacement(TAVR)has evolved to be a well-established option across all risk spectra,with a rapid growth of procedures worldwide.The rise of TAVR initiates the revolution of the management of valvular heart diseases,from patient surveillance,the staging of disease,the use of multimodality imaging,the concept of the Heart Team,new designs and iterations of devices to technical innovations and the discovery of unmet clinical needs.As a consequence of the global adoption of TAVR,geographical differences in the epidemiology of AS and patient characteristics have also been further identied.An examination of the changing patient population,current applications and breakthroughs,and remaining challenges are crucial for the future of this technique.Herein,we discuss the temporal utilization of TAVR,the accumulation of evidence and progress of devices,the selection of patients,and some ongoing topics concerning the improvement of TAVR.

Evaluation of systemic impact of tricuspid regurgitation:an appeal for the notion of tricuspid regurgitation syndrome

Tricuspid regurgitation(TR)is an often encountered but undertreated valvular heart lesion.Unlike left-sided valvular diseases,it is estimated that only 5%of patients with significant TR were treated surgically,among which 86%were treated in combination with other major procedures.[1]This unmet need partially resulted from the lack of prospective evidence on reduced mortality of severe TR benefiting from surgery,alongside a historical viewpoint that functional TR(being the etiology for the vast majority of TR)would be improved once problems in the left heart are corrected.However,untreated severe TR shows various symptoms and a poor prognosis,including increased early and late mortality and impaired quality of life.[2]With the rapid development of catheter-based valve therapies,less invasive treatment options have been offered to the once forgotten tricuspid valve,further expanding the complexity of decision-making for TR intervention.

Gender differences in mortality following tanscatheter aortic valve replacement(TAVR):a single-centre retrospective analysis from China

To the Editor:Transcatheter aortic valve replacement(TAVR)has become an established treatment for patients with severe aortic stenosis(AS)at all levels of surgical risk.^([1,2])With the exploration of TAVR and technological developments,TAVR is an alternative for patients with intermediate or low surgical risk.^([3])There are some studies regarding gender differences in TAVR,but there are few studies on it in Asia.^([4])However,the studies of outcomes based on gender differences in TVAR are still lacking,especially in China and other Asian countries.

Peri-procedural myocardial injury predicts poor short-term prognosis after TAVR:A single-center retrospective analysis from China

To the Editor:Approximately 2%of people>65 years old have aortic stenosis(AS).[1]Without intervention,AS is a rapidly progressive valvular heart disease with a 2-year mortality of 50%.[1]Since the first transcatheter aortic valve replacement(TAVR)was performed by Cribier et al[2]in 2002,TAVR has been suggested to be non-inferior in AS patients of various risk stratifications.Post-TAVR complications are essential in predicting patient survival and improving quality of life,especially with the procedure being performed in an increasing population of low-risk patients.[3]Among them,myocardial infarction(MI)is a rare but life-threatening complication usually caused by the obstruction of coronary ostia.[1]In comparison,peri-procedural myocardial injury,primarily characterized by the elevation of cardiac markers,is a relatively common complication of TAVR.Although recent studies have demonstrated promising results of cardiac markers in predicting cardiovascular adverse events,the impact of peri-procedural myocardial injury on short-term and long-term mortality has yet to be established.

Current Status and Challenges of Valvular Heart Disease Interventional Therapy

Valvular heart disease(VHD)is common in the global population,occupying an heavy disease burden among aging population.Currently,it is the booming era of transcatheter VHD treatment,even with superiority than traditional open heart surgery in some clinical outcomes.We collected data sources mainly derived from published articles and conference presentations,including randomized controlled trials,first-in-man studies,clinical registries,and other single-or multi-center and prospective or retrospective clinical studies.This review summarized the relevant devices and researches of transcatheter aortic valve replacement,transcatheter mitral valve repair and replacement,transcatheter tricuspid valve repair and replacement,and transcatheter pulmonary valve replacement.Moreover,possible challenges of interventional therapy for various VHD in the future were discussed as well.