The year in cardiovascular medicine 2025: the top 10 papers in valvular heart disease

1. Poterucha TJ, Jing L, Ricart RP, et al. Detecting structural heart disease from electrocardiograms using AI. Nature 2025; 644:221–30. doi.org/10.1038/s41586-025-09227-0. We introduce a deep learning model, EchoNext, trained on more than 1 million heart rhythm and imaging records across a large and diverse health system to detect many forms of structural heart disease. These findings support the potential of artificial intelligence to expand access to heart disease screening at scale. To enable further development and transparency, we have publicly released model weights and a large, annotated dataset linking heart rhythm data to imaging-based diagnoses.

2. Long A, Finer J, Hartman H, et al. Deep learning for echocardiographic assessment and risk stratification of aortic, mitral, and tricuspid regurgitation: the DELINEATEregurgitation study. Eur Heart J 2025;46: 2780–91. Classification and risk stratification in aortic (AR), mitral (MR), and tricuspid regurgitation (TR) remains a significant clinical challenge. This study aimed to develop an artificial intelligence (AI) system to assess valvular regurgitation and stratify MR-progression risk. An AI system can accurately classify AR, MR, and TR and predict MR progression beyond currently known risk factors.

3. Généreux P, Banovic M, Kang D, et al. Aortic valve replacement vs clinical surveillance in asymptomatic severe aortic stenosis: a systematic review and meta-analysis. J Am Coll Cardiol 2025;85:912–22. doi.org/ 10.1016/j.jacc.2024.11.006.   Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction. In this meta-analysis of 4 randomized trials, early aortic valve replacement was associated with a significant reduction in unplanned cardiovascular or heart failure hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.

4. Leon MB, Mack MJ, Pibarot P, et al. Transcatheter or surgical aortic-valve replacement in low-risk patients at 7 years. N Engl J Med 2025. doi.org/10.1056/NEJM oa2509766. Five-year data from the PARTNER 3 trial showed that among low-risk patients with severe, symptomatic aortic stenosis, outcomes were similar among patients who had undergone transcatheter aortic-valve replacement (TAVR) and those who had undergone surgical aortic-valve replacement. Longer-term assessments of clinical outcomes and valve durability are needed. Among low-risk patients with severe, symptomatic aortic stenosis, no significant differences with respect to two primary composite end points involving death, stroke, and rehospitalization were observed at 7 years between those who had undergone TAVR and those who had undergone surgery.

5. Jørgensen TH, Savontaus M, Willemen Y, et al. Three-year follow-up of the NOTION-2 trial: TAVR versus SAVR to treat younger low-risk patients with tricuspid or bicuspid aortic stenosis. Circulation 2025;152: 1326–37.   Transcatheter aortic valve replacement (TAVR) is increasingly performed in younger, low surgical risk patients. The NOTION-2 study (The Nordic Aortic Valve Intervention) reports midterm outcomes in low-risk patients age 60 to 75 years with severe tricuspid or bicuspid aortic stenosis undergoing TAVR or surgical valve replacement. For patients age 60 to 75 years with severe aortic stenosis who are at low surgical risk, 3-year clinical outcomes are similar between TAVR and surgery. Both procedures are associated with low rates of structural valve deterioration and need for reintervention.

6. Raposeiras-Roubin S, Amat-Santos IJ, Rossello X, et al. Dapagliflozin in patients undergoing transcatheter aortic-valve implantation. N Engl J Med 2025;392:1396–405. https://doi.org/10.1056/ NEJMoa2500366. Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart-failure admission among high-risk patients. However, most patients with valvular heart disease, including those undergoing transcatheter aortic-valve implantation (TAVI), have been excluded from randomized trials. Among older adults with aortic stenosis undergoing TAVI who were at high risk for heart failure events, dapagliflozin resulted in a significantly lower incidence of death from any cause or worsening of heart failure than standard care alone.

 7. Messika-Zeitoun D, Chu MWA, Bouchard D, et al. Clinical presentation and outcomes after surgery for mitral regurgitation: real- world insights from the MITRACURE international registry. Circulation 2025;152: 927–38.  Comprehensive knowledge of the clinical presentation, contemporary management, and outcomes on “all-comer” patients referred for mitral valve surgery (MVS) are critical to evaluate current practice and adherence to guidelines, understand selection biases, and inform key stakeholders on quality improvement. MITRACURE provides a contemporary, multicenter, “real-world” picture of the clinical presentation, management, and in-hospital outcomes of MVS for MR in two Western countries. Patients were often referred late in the disease process, with few patients undergoing early intervention. The higher mortality and lower repair rates reported may be more reflective of an unselected MR patient population but have room for improvement. Our results underline the need to develop strategies to improve management and outcomes of patients with MR.

 8. Kaneko T, Kagiyama N, Okazaki S, et al. Transcatheter edge-to-edge repair vs medical therapy in atrial functional mitral regurgitation: a propensity score-based comparison from the OCEAN-Mitral and REVEAL-AFMR registries. Eur Heart J 2025. Epub ahead of print. doi.org/10.1093/ eurheartj/ehaf511. Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edgeto-edge repair (TEER) for AFMR has not been. investigated. In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.

 9. Guerrero ME, Daniels DV, Makkar RR, et al. Percutaneous transcatheter valve replacement in individuals with mitral regurgitation unsuitable for surgery or transcatheter edge-to-edge repair: a prospective, multicountry, single-arm trial. Lancet 2025;406:2541–50. https://doi.org/ 10.1016/S0140- 6736(25)02073-2. Patients with severe mitral regurgitation are frequently not candidates for surgery or transcatheter edge-to-edge repair (TEER). We aimed to evaluate 1-year outcomes of a novel percutaneous transseptal transcatheter mitral valve replacement (TMVR) system in patients unsuitable for surgery or TEER. Percutaneous transseptal TMVR with the SAPIEN M3 system effectively reduced mitral regurgitation with low rates of complications and mortality. These findings support percutaneous TMVR with the SAPIEN M3 system as a therapeutic option for patients who are unsuitable for surgery or TEER.

10. Kar S, Makkar RR, Whisenant BK, Hamid N, Naik H, Tadros P, et al. Two-year outcomes of transcatheter edge-to-edge repair for severe tricuspid regurgitation: the TRILUMINATE pivotal randomized controlled trial. Circulation 2025;151:1630–8. One-year outcomes of TRILUMINATE Pivotal (Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System Pivotal) found that transcatheter edge-to-edge repair (TEER) for the treatment of severe, symptomatic tricuspid regurgitation improved quality of life compared with medical therapy alone with similar rates of mortality and heart failure hospitalization. However, additional follow-up is necessary to determine the prolonged benefits of tricuspid TEER. At the 2-year follow-up, tricuspid TEER appeared safe, significantly reduced tricuspid regurgitation severity, and decreased rates of heart failure hospitalization compared with medical therapy alone.