Technical innovations in heart failure and mitral valve disease

Transformative changes have substantially improved patient outcomes in the intertwined field of heart failure (HF) and mitral valve regurgitation (MR). Despite these advancements in therapies, challenges remain: medical therapies for HF are highly underutilized worldwide, women are often underrepresented in landmark clinical trials so sex specific analysis are needed, and patient specific models for training or surgical planning in novel interventions warrant additional developments. Part I discusses digital solutions that can improve the usage of guideline directed medical therapies (GDMT). Existing digital solutions to improve GDMT are reviewed and directions for future research are identified. The design and results of the ADMINISTER trial are subsequently described. The ADMINISTER trial showed that optimization using digital consults was effective to improve GDMT within 12 weeks. This can improve healthcare systems by making HF care more efficient, while also improving patient outcomes. Part II focused on technical innovations in mitral valve disease. A sex specific analyses emphasized the high mortality of patients with MR, and identified low GDMT usage as a way to improve patient outcomes, especially in the vulnerable group of males with secondary MR. Developments in fusion and flexible 3D printing for interventional planning are then described. These technical developments allow for improved planning and simulation of these interventions. Future directions include clinical trials designed to test the effectiveness of digital solutions for GDMT optimization on the endpoints of all-cause mortality and hospitalizations as well as trials on whether 3D prints and surgical simulations can improve indicators of surgical performance.