Call for Papers: Narrow aortic root: preventing and treating patient-prosthesis mismatch after TAVI and SAVR
Interdisciplinary CardioVascular and Thoracic Surgery (ICVTS) is a fully Open Access online-only journal dedicated to fostering collaboration across multidisciplinary teams in Cardiac, Thoracic, and Vascular Surgery.
Browse the narrow aortic root call for papers and contribute your work to the journal. Explore the Author Guidelines page for more information on submitting your work.
Scope of the collection
Patient-prosthesis mismatch, first described in 1978 by Rahimtoola, can be defined as implanting too small a prosthetic heart valve for the patient’s size, causing high transvalvular gradients.
The interpretation of patient-prosthesis mismatch, its clinical importance, and even its actual existence are still controversial; however, it has been reported by many as an important cause of adverse outcomes following AVR, in terms of left ventricle mass regression, and survival. A stenotic prosthetic valve may cause unsatisfactory symptom relief and less evident improvements in functional capacity, life quality and life expectancy, ending up with congestive heart failure or sudden death. Therefore, the primary concern when dealing with a small aortic annulus is the fear of creating a patient-prosthesis mismatch by implanting a prosthesis that is too small for the patient’s size.
Unfortunately, the number of affected people is increasing with the current liberal use of small-size mechanical prostheses in aortic position. The incidental reports denying the importance of patient-prosthesis mismatch or overstating the hemodynamic performance of small-size prosthetic valves encourage this trend. A small annulus may represent a challenge for the surgeon, yet it can be best managed at the initial operation using relatively simple techniques. Later on, correction is often far more challenging. The corrective reoperations include drastic aortic annulus enlargement in order to replace the previously implanted stenotic valve with a considerably larger one. Several such techniques involving posterior (Nicks, Manougian) or anterior (Konno) approaches have been described. Nevertheless, the relief of patient-prosthesis mismatch generally requires a reoperation of a comprehensive nature, which dictates an extensive aortic root enlargement. There is also some subvalvular obstruction with long-standing severe patient-prosthesis mismatch due to secondary myocardial hypertrophy in the left ventricular outflow tract. This subvalvular obstruction also needs to be eliminated, as it may interfere with the success of the aortic root enlargement and function of the new (and presumably larger) prosthetic valve that replaces the previously implanted stenotic prosthesis.
The introduction of transcatheter aortic valve implantation (TAVI) added another dimension to these ongoing discussions, leading to another point of debate. While initial reports pointed to an increased rate of patient-prosthesis mismatch development after TAVI, more recent studies claim the opposite- that the incidence of patient-prosthesis mismatch is actually decreased compared to that seen after surgical aortic valve replacement.
Although this topic focuses on small aortic valve annulus, the studies failed to demonstrate consistently and uniformly any association between patient-prosthesis mismatch and long-term mortality/morbidity. As there may be several reasons masking the real impact of patient-prosthesis mismatch, the present data should be interpreted with caution to avoid a potentially misleading perception.
This call for papers will collect papers discussing how to deal with a small annulus in patients requiring aortic valve replacement/implantation, the actual short- and long-term impacts of patient-prosthesis mismatch, its prevalence in TAVI vs. surgical AVR series, techniques to avoid untoward outcomes and its treatment.
Potential manuscripts are expected to discuss the following points:
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How to deal with a narrow (small) aortic annulus when a prosthetic aortic valve replacement is necessary?
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What is the actual impact of patient-prosthesis mismatch? Is it clinically important? What can be the actual adverse outcomes?
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In a case with a small aortic annulus, is TAVI a better choice than surgical AVR for avoiding or at least minimizing patient-prosthesis mismatch? Is a small aortic annulus an indication for TAVI?
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How to best address a patient with a previously inserted small prosthetic valve causing patient-prosthesis mismatch? When does a re-replacement with a bigger prosthesis become imperative? What are the surgical options? Is it necessary to simultaneously address the secondary subvalvular muscle hypertrophy?
Deadline: 31st January 2026
Types of papers that could be submitted:
Original articles, reviews and meta-analysis, case reports, brief communications, and invited commentaries.
Guest editor biography: Kerem M. Vural
Dr. Kerem Vural is a full clinical professor of cardiovascular surgery, a surgeon, and an academician at the Hacettepe University Hospitals and School of Medicine. He is an active and board-certified (E.B.T.C.S.) member of the European Association for Cardio-Thoracic Surgery (E.A.C.T.S.) and a member of the Society of Thoracic Surgeons (S.T.S.). He worked as an Executive Committee member of the Turkish Board of Cardiovascular Surgery. Serving as the "Education & Training Program Director" at the Cardiovascular Department at his home university, Dr. Vural's current research interests lie primarily in training the next generation of cardiovascular surgeons.
Interested in Submitting Your Work?
If you’re interested in submitting your research to this call for papers, take a look at the following links for more information about publishing with Interdisciplinary CardioVascular and Thoracic Surgery.
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