J Thorac Dis. 2026 May 31;18(5):550. doi: 10.21037/jtd-2026-0842. Epub 2026 May 18.
ABSTRACT
BACKGROUND AND OBJECTIVE: The field of surgical treatment for valvular heart disease (VHD) has progressed rapidly in 2025. This review aims to summarize the year's key research, focusing on comparisons of mainstream techniques for aortic, mitral, and tricuspid valve diseases, innovations in repair techniques, and advances in emerging technologies, to provide evidence-based support for individualized clinical decision-making.
METHODS: A structured search of PubMed database was performed to identify randomized controlled trials (RCTs), registry studies, and meta-analyses published in 2025, and the evidence was synthesized narratively.
KEY CONTENT AND FINDINGS: In the aortic valve arena, long-term follow-up from the PARTNER 3 and Evolut Low Risk trials confirmed the non-inferiority of transcatheter aortic valve replacement (TAVR) in low-risk patients. However, real-world data suggested higher long-term risks with TAVR in patients with bicuspid aortic valves (BAV) and younger patients, whereas women demonstrated greater benefit. The indication for early intervention in asymptomatic severe aortic stenosis (AS) was reinforced. Aortic valve repair and the Ross procedure accumulated more robust evidence for long-term survival and quality of life in younger patients. In the mitral valve domain, the MITRACURE study highlighted gaps between real-world practice and guidelines, including delayed referral and suboptimal repair rates for mitral regurgitation (MR). The advantages of repair for degenerative disease were further solidified, though techniques for posterior leaflet prolapse and management strategies for atrial functional regurgitation (AFMR) require optimization. Transcatheter edge-to-edge repair (TEER) was increasingly used in high-risk patients but yielded inferior long-term outcomes compared to surgery, and surgical rescue after failed TEER carried high risk. For the tricuspid valve, comparative effectiveness of transcatheter vs. surgical repair and the timing of intervention emerged as key research foci. Emerging technologies such as polymer valves, partial heart transplantation, and artificial intelligence (AI)-assisted analysis demonstrated preliminary potential.
CONCLUSIONS: The 2025 evidence reinforces a paradigm shift from risk-score-based decision-making toward individualized valve care. Transcatheter techniques have expanded their indications, but surgery remains irreplaceable in young, low-risk, and BAV patients, as well as in degenerative MR. Real-world gaps in guideline adherence, delayed referral, and suboptimal repair rates require urgent attention. Emerging technologies show early promise, although their long term durability and clinical value await further validation.
PMID:42306693 | PMC:PMC13266806 | DOI:10.21037/jtd-2026-0842