Table 3.

Preprocedure Therapy and Management—Patient‐Centered Research Questions in VHD

Prevent/slow/reverse VHD with medical therapy What factors are associated with the development and progression of VHD? What medical therapies (currently available or targeting new pathways) are effective at slowing or reversing established VHD?

Prevent/slow/reverse maladaptive ventricular remodeling and dysfunction with medical therapy What factors/pathways are associated with the development and progression of maladaptive ventricular remodeling and dysfunction in the setting of pressure or volume overload? Despite potentially progressive valve disease, are there medical therapies that could prevent, slow, or reverse adverse consequences to the ventricle resulting from pressure or volume overload? If so, what is the optimal timing for those therapies to be utilized? What differences exist between the right and left ventricles with respect to pathophysiology and targets for and timing and efficacy of intervention with medical therapy?

“Prehabilitation” in frail patients In patients with impaired physical function needing a valve procedure, does a rehabilitation strategy before intervention improve periprocedural and short‐term outcomes? What types of prehabilitation are feasible and which components (eg, resistance exercise, aerobic exercise, reducing sedentary behavior, and nutrition) are most important? What patient‐centered delivery strategies are best suited to optimize the impact of prehabilitation programs?

Blood pressure targets in patients with VHD What are the optimal blood pressure targets in patients with VHD? Should they differ from the general population? How do age, type of valve disease, severity of valve disease, and comorbidities influence optimal targets for blood pressure?

Activity recommendations and restrictions in patients with VHD before a procedure What activities and exercises promote the progression or increased risk of adverse events for specific types of VHD? What activity recommendations should be made to patients with VHD? How can this evidence be best conveyed?

VHD indicates valvular heart disease.