About this Research Topic

Background

Although bioprosthetic heart valves provide patients with a significantly better quality of life and fewer debilitating complications than mechanical valves, their rapid degeneration in young recipients limits their use to patients in their sixties and older. The consequence of this restriction particularly affects low- to middle-income countries where the vast majority of patients in need of heart valve replacements live. A significant proportion of these are in their fourties and often have limited access to open heart surgery as well as controlled anticoagulation. On the other end of the spectrum are high-income countries where the limitation of bioprosthetic valves to older patients excludes younger patients from receiving trans-catheter valves. Simplified transcatheter technologies and long-lasting soft-leaflet materials would therefore not only offer hope to the millions of patients in the less affluent part of the world but also remove the current age-ceiling on transcatheter valves in high income countries.

The objective of this issue of ‘Frontiers in Cardiovascular Medicine’ is to outline the evolving synergism of new horizons in heart valve replacement between affluent countries and emerging economies. In the center of this synergism stands the shared need for long-lasting soft-leaflet heart valve prostheses. Emerging economies need them to reduce the morbidity and mortality associated with mechanical heart valves in their predominantly young patients with rheumatic heart disease. Industrialized countries also need them to be able to expand trans-catheter technologies beyond their current restriction to elderly recipients.

Creating awareness for the fact that the needs are global will strengthen the momentum for a quantum leap development in prosthetic heart valves. As such, facilitating insight into the requirements and limitations of all patients of emerging economies and not only the urban, affluent few who mirror Western pathologies and can afford expensive Western therapies is one goal of this issue. Reviewing the level of scientific insight and developmental achievements towards game-changing soft-leaflet valves is another. The ultimate goal is to create awareness for the indirect benefits solutions for middle-income countries may hold for the industrialized world.

With a focus on soft leaflet heart valves from bioprosthetic to polymer, the scope of the Research Topic reaches from global needs to recent science behind leaflet longevity to the possibilities a synoptic approach offers to the patients of both emerging economies and industrialized countries.

Contributors are encouraged to address inter alia the following main themes in ‘opinionated’ systematic reviews:
1) “Global Needs”: Addressing the transition from the current ‘unipolar’ world of heart valve surgery dominated by Western high-income countries (HICs) addressing the needs of their aging patients with degenerative valve disease to a ’multi-polar’ realm catering for all heart valve patients in need of intervention including the millions of young patients with rheumatic heart disease in middle-income countries (MICs).
2) “Confounding Circumstances”: Guidelines for HV replacement of HICs are currently used globally although they are poorly suited for the patients of MICs. Appraising global aspects towards a ‘needs-momentum’ will form a crucial part of this topic.
3) “Improving the longevity of soft-leaflet Heart Valves”: forms the backbone of this Research Topic ranging from contemporary degeneration profiles of ‘tissue valves’ to key bioprosthetic issues such as sophisticated cross link chemistry, immunogenicity, decellularization and alternative materials such as polymers.
4) “Facilitating Access to HV replacement”: through socio-economic models or global alliances
5) “Expanding trans-catheter technologies”: The current restriction of trans-catheter HV replacement to elderly patients of HICs with degenerative aortic stenosis and a few with degenerative aortic regurgitation limits a game-changing technology to a fraction of potential patients. Extending it to a global majority on the back of extended leaflet longevity will require to widen the use of trans-catheter heart valve replacements both indication wise and pathology-wise. As such, contributions addressing the fringes of contemporary TAVR experience will greatly facilitate this process.

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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