From Biology To Clinical Management An Update On Aortic Valve Disease 2nd Edition

Calcific aortic valve stenosis is the most frequent valvular heart disease in Western countries, affecting up to 13% of individuals over 75 years. The disease is associated with considerable morbidity and mortality. It is characterized by fibro-calcification of aortic valve cusps and concomitant left ventricular remodelling due to chronic pressure overload, which can evolve into overt heart failure. It progresses very slowly until the onset of symptoms, the indication for aortic valve replacement. Today, about 300,000 aortic valve replacements are performed annually worldwide, either via surgery or transcatheter implantation. This is the only treatment shown to improve survival. There is no pharmacological treatment to prevent or slow disease progression. Major risk factors include older age, congenital anomalies of the aortic valve (bicuspid valve), male gender, hypertension, dyslipidaemia, smoking, and diabetes. However, how these factors contribute to the disease in unclear. Due to the disease itself, patients are at increased risk of both thrombosis and bleeding, which, in addition to advanced age and comorbidities, makes antithrombotic management of these patients difficult. Regarding valve prostheses, the ideal prosthesis either mechanical or biological still does not exist. Clinically available prostheses can lead to major complications, thrombosis or infection, which necessitate reoperation or cause death in 50-60% of patients within 10 years post-implantation. Hence, there are major unmet medical needs in CAVS and more basic and translational research is definitely required. Our Research Topic depicts major challenges and research paths that could be followed to address these major health needs.