p.72 抽出テキスト

Heart Team and Heart Valve Centre • Structured research is required to investigate the relationship between procedural volume and clinical outcomes, in order to define minimum annual thresholds for individual operators and institutions undertaking surgical and transcatheter valve interventions. • There is a pressing need to ensure higher dispersion and adoption of interventions for VHD, especially in middle- and low-income countries.

Conditions associated with valvular heart disease • CAD: – The prognostic value of functional assessment of stable, moderate

coronary stenosis in VHD patients remains to be determined. – The optimal strategy (invasive vs non-invasive) for CAD assessment in specific VHD populations remains to be elucidated. – The optimal timing of PCI in patients with CAD undergoing TAVI is yet to be determined. – The benefit of complete coronary revascularization with CABG in patients with combined VHD and CAD requires further research. • AF: – It is unclear which patients with chronic persistent AF and con-

comitant VHD are deemed to be suitable for rhythm control therapy. – The protective effect against stroke of OAC with VKA or DOACs in patients after surgical or transcatheter LAAO remains to be determined. • Cardiogenic shock and acute HF: – The optimal treatment strategy in VHD patients presenting with

cardiogenic shock and acute HF is unknown.

Aortic regurgitation • Impact of early LV remodelling on prognosis in asymptomatic AR patients is unknown. • Prognostic value of CMR-derived indices in asymptomatic patients needs to be determined. • More data are required on long-term results of surgical AV repair for AR. • More evidence is required on transcatheter treatment options for AR, in particular using dedicated devices.

Aortic stenosis • Better understanding of the pathophysiology of AS is needed to propose innovative medical therapy. • Further research is required on: – Refined prognostic markers to guide timing of intervention in

asymptomatic patients. – The role of revascularization in patients with severe AS and asymptomatic concomitant CAD. – Further data on the long-term durability of transcatheter valves in comparison with surgical BHVs in younger patients. – The role of TAVI in patients with BAV AS and patients <70 years of age. – Results of intervention (valve or coronary) after TAVI or SAVR. – Determining the optimal lifetime management strategy for AS

patients.

Mitral regurgitation • The association between primary MR and ventricular arrhythmias requires more investigation, including the impact of intervention on ventricular arrhythmias. • More data are required on the role of TEER in patients with advanced HF. • Long-term results of TEER need to be further assessed, including the clinical relevance of transmitral gradients after treatment of both primary and secondary MR. • Results of ongoing trials comparing MV surgery with TEER in nonhigh risk primary MR patients are awaited. • Data on the mid- and long-term clinical impacts of transcatheter MV replacement are required. • More data on the clinical impacts of surgical and transcatheter treatment of atrial SMR are required.

Mitral stenosis • The potential role of TMVI using dedicated devices in high-risk patients is to be determined, particularly those with severe MAC.

Tricuspid regurgitation • The long-term risks and benefits of concomitant TV surgery in patients with less than moderate TR and annular dilatation undergoing left-sided valve surgery need to be determined. • Further investigations are required on the outcomes of TV intervention in asymptomatic patients with severe TR and RV dysfunction or significant dilation. • The importance of addressing concomitant AF in patients with TR needs to be investigated. • More data are required on the indications, timing, and long-term outcomes of TV repair and replacement for TV disease. • Better understanding is required of the respective role of surgery vs transcatheter TV therapy for TR treatment.

Tricuspid stenosis • The role of transcatheter TV replacement remains unexplored in patients with TS. The most efficient way to achieve ventricular pacing in patients after TV replacement needs to be investigated.

Multiple and mixed valvular heart disease • Further evaluation of the impact on outcomes and indication for intervention, as well as timing and modalities of intervention, is required.

Prosthetic valves • Further development of current prosthetic valve devices is required to address their main complications (e.g. improved tissue processing to reduce degeneration of bioprostheses or new mechanical valve designs to reduce risk of thrombosis). • Antithrombotic drugs in MHV patients: – Whether UFH or LMWH should be preferred as bridging therapy

after MHV implantation, as well as their timing and dosage, remains to be established. – For patients with MHV undergoing major NCS, the optimal postoperative management and bridging of VKA needs further investigation. – The role of pharmacogenomics for VKORC1, CYP2C9, and CYP4F2 in patients with highly variable INR, and low TTR or major vascular complications despite good adherence, should be further investigated. – More data on the risks and benefits of slow thrombolysis for valve

thrombosis are required. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026