Transcatheter Tricuspid Valve Replacement: will it take over? Review Article

Review ariticle | DOI: https://doi.org/10.31579/2690-4861/630

Transcatheter Tricuspid Valve Replacement: will it take over? Review Article

  • Zhang Xiling 1,2
  • Nina Sophie Pommert 1,2
  • David Meier 3
  • Stephanie L. Sellers 4,5,6
  • Hatim Seoudy 2,7
  • Oliver J. Müller 2,7
  • Derk Frank 2,7
  • Tim Attmann 1,2
  • Rouven Berndt 8
  • Gregor Warnecke 1,2
  • Thomas Puehler 1,2
  • Georg Lutter 1,2*

1Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany.

2DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. 

3Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

4 Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, Canada.

5Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada.

6Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

7Department of Cardiology and Angiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany.

8Department of Vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany (R.B.).

*Corresponding Author: Georg Lutter, Department of Cardiac Surgery, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany.

Citation: Zhang Xiling, Nina Sophie Pommert, David Meier, Stephanie L. Sellers, Hatim Seoudy, et al, (2025), Transcatheter Tricuspid Valve Replacement: will it take over? Review Article, International Journal of Clinical Case Reports and Reviews, 22(4); DOI:10.31579/2690-4861/630

Copyright: © 2025, Georg Lutter. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 26 November 2024 | Accepted: 17 December 2024 | Published: 22 January 2025

Keywords: tricuspid regurgitation; heart valve replacement; transcatheter; stents; clini-cal outcomes

Abstract

Severe tricuspid regurgitation (TR) is a prevalent and challenging condition associated with poor survival outcomes and significant morbidtiy. Medical therapy alone often fails to provide adequate symptom relief, and standalone surgical intervention is liked to high mortality rates, making it a less favorable option unless combined with left-sided valve surgery. 

The advent of transcatheter tricuspid interventions has provided new therapeutic possi-bilities, particularly for high-risk patients who are ineligible for conventional surgery. However, many patients remain unsuitable for transcatheter tricuspid repair, or achieve only limited benefits from such procedures. In this context, Transcatheter tricuspid valve replacement (TTVR) has rapidly emerged as a promising alternative, offering the po-tential for more effective treatment outcomes. This review explores the latest advance-ments in TTVR devices, highlights key clinical experiences, and discusses the chal-lenges and limitations of this evolving strategy. Additionally, we address patient selec-tion criteria, procedural outcomes, and future directions in the field, emphasizing the potential of TTVR to transform the management of severe TR.

Introduction

Tricuspid regurgitation (TR) is a prevalent form of valvular heart disease with extensive research establishing its severity as an independent predictor of mortality[1]. The European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines recommend tricuspid valve repair or replacement for patients with moderate to severe primary or secondary TR, especially when performed in conjunction with left-sided heart surgery, as a Class I indication[2]. However, managing isolated TR, particularly when accompanied by right ventricular dysfunction, remains challenging, with perioperative mortality rates reaching up to 10%[2].

Transcatheter tricuspid valve intervention (TTVI) offers an innovative therapeutic approach aimed at mitigating the risks associated with conventional surgical procedures. Moreover, compared to treatment with oral medications alone, TTVI may be associated with higher survival rates and lower rates of heart failure rehospitalization[3]. Recent advancements have introduced various TTVI techniques, providing minimally invasive alternatives that have shown promising initial results. The spectrum of TTVI includes both transcatheter tricuspid valve repair (TTVr) and replacement (TTVR), each tailored to specific patient needs. While TTVr has demonstrated commendable safety and efficacy, anatomical considerations such as unfavorable tricuspid valve morphology, or excessive annular dilatation with large coaptation gap may preclude the use of edge-to-edge repair. For these individuals, TTVR sometimes represents the only potential alternative[4].

This review will comprehensively examine the different types of valves currently available and their respective statuses in clinical trials. Furthermore, it will analyze the ongoing challenges and developmental trends in the field of TTVR, emphasizing its potential to significantly advance the therapeutic landscape for TR.

Transcatheter Tricuspid Valve Replacement-Current Landscape

Since the first-in-human implantation, TTVR has advanced rapidly[5]. Early devices were temporarily set aside due to technical limitations and the complex anatomy of the tricuspid valve, which posed challenges in initial design and clinical application. However, with advancements in imaging navigation, catheter technology, and materials science, TTVR techniques have gradually improved, now encompassing two primary approaches: orthotopic and heterotopic replacement. Orthotopic replacement involves directly implanting a new valve at the tricuspid valve site, while heterotopic replacement positions the valve stent within the vena cava[6]. Multiple new devices are currently entering clinical trials, with some demonstrating significant efficacy in high-risk patients, thereby promoting the standardization and diversification of TTVR techniques. Table 1 shows the orthotopic and heterotopic tricuspid valve replacement devices currently under development and tested.

DeviceManufacturerAccessAnchoringTrials
Orthotopic    
VDyneVDyneTransfemoralSeptal anchorNCT05797519
CardiovalveVenus MedTechTransfemoralTV leafletsNCT04100720

LuX-Valve

Lux-Valve Plus

Jenscare Biotechnology

Transatrial

Transjugular

Septal anchor and anterior leaflet grasp

NCT05436028

NCT05436028

EVOQUE*Edwards LifescienceTransfemoral

TV leaflets/

annulus

NCT04221490

NCT04482062

IntrepidMedtronicTransfemoralPerimeter oversizingNCT04433065
TrisolTrisol MedicalTransjugularTricuspid annulusNCT04905017
TRiCaresTRiCaresTransfemoralTricuspid annulusNCT05126030
NaviGateNaviGate Cardiac StructuresTransatrial

TV leaflets/

annulus

N/A
Heterotopic    
Sapien XTEdwards LifescienceTransfemoralPreceding stent implantationNCT02339974
TricValveP+F Products + FeaturesTransfemoralN/ANCT04141137
TricentoMEDIRATransfemoralN/AN/A

Table 1: Orthotopic and heterotopic tricuspid valve replacement devices currently under development and tested. The Evoque valved stent received CE mark*. The scaffolds of these valved stents are made of nitinol. TV: tricuspid valve

Orthotopic Transcatheter Tricuspid Valve Replacement

VDyne

The VDyne valve (VDyne, Inc., Maple Grove, MN, USA, Fig. 1A) consists of a dual-frame nitinol prosthesis, housing a 30 mm porcine tri-leaflet valve. The outer frame is asymmetrically designed (like an oyster, pear-like) with five different fixation mechanisms: a tab at the right ventricular outflow tract, small tabs at the lateral or free wall of the right ventricle (RV), a small tab at the postero-septal wall, and a large tab beyond the posterior annulus. This design aims to anatomically conform to the native annulus while allowing for minor oversizing (larger atrial and ventricular hub). The valve is available in five sizes, suitable for any tricuspid annulus with a circumference of up to 180 mm. Additional sizes under development. The valve is deployed using a single 28Fr catheter and features a unique side-loading delivery system in which the prosthesis is crimped vertically rather than radially. Even after full expansion and positioning it can be fully recaptured[7].

The initial thirteen patients receiving the 3rd generation of human implants were all successfully treated[7]. Early feasibility trials are currently underway in multiple regions globally (VISTA, NCT05797519), and the device has been designated as a breakthrough device by the U.S. Food and Drug Administration (FDA).

Cardiovalve

The Cardiovalve (Venus MedTech, Hangzhou, China, Fig. 1B) device comprises a self-expanding nitinol stent and bovine pericardial leaflets. It 

features an atrial flange to assist with anchoring and incorporates leaflet capture technology to prevent valve migration. The valve is delivered via a low-profile 28F delivery system through the femoral vein. The Cardiovalve is suitable for patients with an annulus diameter ranging from 36 to 55 mm and a right ventricular length exceeding 45 mm[8].

Currently, an early feasibility study of Cardio valve is being conducted in the United States (NCT04100720), enrolling 15 patients. The primary endpoints include the absence of device- or procedure-related adverse events within 30 days post-procedure. However, this study has been intermittently interrupted due to technical issues. The new TARGET trial has commenced (NCT05486832), aiming to enroll 100 patients to evaluate the safety and performance of the Cardio valve system.

LuX-Valve

The LuX-Valve (Jenscare Biotechnology, Ningbo, China, Fig. 1C) is a self-expanding bovine pericardial valve also mounted on a nitinol stent. It stands out from traditional stent devices with its unique anchoring mechanism, which secures placement through anterior leaflet clamps and a ventricular anchor, significantly reducing stress on the cardiac walls and minimizing the risk of complications.

This innovative bioprosthesis is available in four sizes, ranging from 30 to 55 mm, and includes eight skirted atrial disc options, making it suitable for native tricuspid annulus diameters from 25 to 50 mm. Implantation is facilitated by a flexible 32Fr delivery system via a transatrial approach, enhancing procedural adaptability and patient recovery[9].

In clinical evaluations, Lu et al.[9] documented the first deployment of the LuX-Valve for transcatheter tricuspid valve replacement in patients at high risk for tricuspid regurgitation. The procedure was successful in all 12 patients, with 90.9% exhibiting no residual tricuspid regurgitation at the 30-day postoperative follow-up. 

Additionally, Sun et al.[10] observed a significant reduction in tricuspid regurgitation severity over a 12-month period in a similar patient cohort, although one patient succumbed to right heart failure within three months post-operation.

The second-generation LuX-Valve is transitioning to a transjugular approach. The first-in-human study of the LuX-Valve Plus demonstrated significant results, with all patients successfully receiving the implant and achieving none/trace TR within 30 days[11]. Results from 76 patients under early compassionate use showed that at 1 month, 95.0% of patients had TR of ≤2+, and 86.8% had TR of ≤1+[12].

Currently, multiple studies (NCT06568003, NCT05436028) are evaluating the safety and efficacy of transjugular tricuspid valve replacement using the LuX-Valve Plus system.

Evoque

The EVOQUE tricuspid valve replacement system (Edwards Lifescience, Irvine, CA, USA, Fig. 1D) features a self-expanding nitinol stent, bovine pericardial leaflets, an intra-annular sealing skirt, and anchoring devices. This system is available in three sizes: In 44 mm, 48 mm, and in 52 mm. It utilizes a low-profile, multi-plane 28Fr delivery system designed for femoral artery implantation, making it adaptable to a wide range of anatomical structures.

The TRISCEND trial (NCT04221490) evaluated the safety and performance of the EVOQUE system in patients with symptomatic TR of at least moderate severity, despite receiving medical therapy. At 1 year, 97.6% of implanted patients had TR of mild or less, with 69.0% exhibiting none or only trace TR[13]. 

The TRISCEND II trial (NCT04482062) aims to assess the safety and efficacy of the EVOQUE system compared to optimal medical therapy (OMT) for patients with at least severe TR. Initial six-month follow-up results from the first 150 patients demonstrated that the EVOQUE system effectively eliminated TR in approximately 78% of participants, with nearly 99

Current status and challenges

Timing of Intervention

For intervention in TR, currently only the ESC/ EACTS guidelines provide a Class I indication, which is for severe symptomatic TR. Wang et al[31]. compared the characteristics and outcomes of patients with Class I indications for severe symptomatic TR to those without such indications who underwent early surgery. The results showed significantly better short- and long-term outcomes in the early surgery group. Although the patients in Class I were older, with more pronounced symptoms and higher NYHA classifications, resulting in notable differences in baseline characteristics, the small sample size may also have influenced these findings. Nevertheless, this raises a new consideration: should we wait until Class I indications are met before intervening? In fact, the longer the wait for Class I indications, the greater the likelihood of developing risk factors such as right ventricular dysfunction, atrial fibrillation, and renal impairment, which in turn increase both surgical and long-term risks. With the emergence and advancement of new TTVI devices, a lower-risk surgical alternative is now available, potentially offering a new therapeutic strategy for early intervention in TR.

Patient selection

Clinically, secondary TR accounts for 90% of all TR cases[32]. In the early stages of the disease[33], where right ventricular dilation is not yet severe and tricuspid annular dilation occurs without significant leaflet tethering, transcatheter annuloplasty systems like the Cardioband. Tricuspid Valve Repair System are effective in repairing TR[34]. As the disease progresses to the second stage, further dilation of the RV and tricuspid annulus compromises leaflet coaptation, resulting in progressive leaflet tethering. At this juncture, the likelihood of achieving successful repair with an annuloplasty ring alone diminishes, necessitating a combination of edge-to-edge repair and annuloplasty[35, 36]. Notably, performing TTVR at this stage may completely resolve TR. Compared to transcatheter edge-to-edge repair, TTVR can attain a mild or lesser degree of residual TR in almost all patients within 30 days and 1-year (Figure 3)[9, 10, 37-41]. This resolution of TR can be maintained for up to one year, showcasing favorable functional outcomes that may positively influence long-term survival and functional status. In the third stage, as leaflet tethering further deteriorates, TR escalates to massive or torrential levels, rendering repair efforts potentially futile[42].

For patients with preserved or mildly to moderately impaired right ventricular function, TTVR should be considered the treatment of choice. In patients with end-stage heart failure who are on pharmacological treatment, employing TTVR or CAVI as a compassionate therapy is viable, but requires meticulous assessment of the patient’s condition[43].

Apart from survival rates, improvements in quality of life are also an important consideration. In both the TRILUMINATE pivotal trial[44] and the TRISCEND II pivotal trial[45], significant quality of life benefits were observed compared to OMT alone, and these benefits were associated with the degree of TR reduction. In the TRILUMINATE trial, improvements in Kansas City Cardiomyopathy Questionnaire Overall Summary Score scores were similar across groups, regardless of baseline TR severity. In contrast, in the TRISCEND II trial, the extent of quality of life improvement was directly related to baseline TR severity, with patients with more severe baseline TR experiencing greater health status benefits[45]. In addition, there were differences in the timeline of health status improvement between the two trials. In the TRILUMINATE Pivotal trial, the majority of patients showed significant improvement by 30 days post–transcatheter edge-to-edge repair. In contrast, in the TRISCEND II Pivotal trial, only moderate improvement was observed at 30 days, with continued improvement over the following six months[45]. This may be due to a transient increase in right ventricular afterload associated with TTVR.

Based on experience with mitral valve surgery, valve repair is generally prioritized over valve replacement, as conventional valve replacement surgery requires resection of subvalvular structures. This disruption to the subvalvular apparatus can damage the normal ventricular architecture, gradually leading to ventricular ‘sphericalization’ and impairing ventricular function[46, 47]. TTVR does not directly affect the papillary muscles and chordae tendineae; however, the implanted prosthetic valve stent may exert a mild mechanical effect on adjacent tissues. In certain cases, the position of the implant may slightly alter the geometry of the right ventricle, indirectly impacting the position and tension of the papillary muscles. Nevertheless, this effect is typically minimal and, in the vast majority of cases, does not lead to functional abnormalities.

CAVI is specifically engineered to alleviate congestion in patients with severe torrential TR who are either ineligible for surgery or present a high surgical risk. The fundamental mechanism of CAVI involves deploying a valved stent at the junction between the inferior vena cava and the right atrium to mitigate regurgitation. This intervention significantly reduces hepatic congestion, which subsequently improves hepatic and renal function, leading to decreased symptoms only of ascites and peripheral edema[48]. Moreover, CAVI has the potential to enhance right ventricular output, thereby augmenting cardiac output. Nonetheless, it is important to note that this approach is unlikely to ameliorate right ventricular function or influence the process of right ventricular reshape remodeling, thus categorizing it as a palliative procedure.

From the perspectives of safety and efficacy, the technology underpinning CAVI continues to necessitate rigorous validation through ongoing clinical trials. Furthermore, its effectiveness must be evaluated against optimal medical therapy within the framework of randomized controlled trials to establish a robust base of evidence.

Figure 3: Thirty-day and one-year outcomes of transcatheter tricuspid valve intervention[9, 10, 37-41]


 

Valve durability and anticoagulation

Similar to transcatheter aortic or mitral valves, an inevitable issue with transcatheter tricuspid valves is their durability. Based on past experiences, the durability of bioprosthetic valves typically ranges from 10 to 15 years[49, 50]. However, the durability of right-sided cardiac transcatheter bioprosthetic valved stents remains unclear. The location of the tricuspid valve makes it more susceptible to the complex hemodynamic effects within the heart, particularly in the low-pressure regions. Although the pressure in this area is relatively low, factors such as regurgitation and turbulent flow contribute to increased risks of calcification and wear. Consequently, the durability of the tricuspid valve is generally lower compared to other heart valves. Tissue-engineered bioabsorbable heart valves may offer a strategic approach. Currently, tissue-engineered heart valves have achieved encouraging results in the pulmonary valve domain[51]. Nevertheless, further research is required in the tricuspid valve area.

Currently, there is a lack of evidence-based guidelines for antithrombotic therapy in patients undergoing transcatheter tricuspid valve interventions[52]. Drawing from the experience with surgical bioprosthetic valves, in the absence of an indication for long-term oral anticoagulation (OAC), it is considered reasonable to administer vitamin K antagonists for 6 months following TTVR[53]. Notably, due to the relatively lower blood flow in the right heart chambers, the risk of thrombosis in right-sided prosthetic valves is higher than in left-sided valves[54]. Therefore, an extended duration of OAC may be recommended. After TTVr, single antiplatelet therapy may be considered. However, since most patients already require anticoagulation due to pre-existing atrial fibrillation, they are typically maintained on long-term OAC[55]. Major bleeding is the most common serious complication following TTVI, highlighting the need for further research to determine the optimal duration of anticoagulation after transcatheter tricuspid valve intervention.

Right ventricular dysfunction

Although transcatheter TTVR can effectively eliminate TR, a subsequent complication is the decline in RV function. Right ventricular systolic dysfunction persists 30 days post-operation, which may indicate that the mechanical function of the RV had already been impaired under chronic severe TR but was masked by the reduced afterload[56]. Following TTVR, the significant reduction in TR leads to a sharp increase in afterload, thereby negatively affecting RV function.

Sugimoto et al[57]. proposed a novel load-independent method for measuring RV contractility and found that RV dysfunction in patients with severe TR at baseline did not change after tricuspid valve surgery. While postoperative RV function can predict the outcomes of tricuspid valve surgery, the results of transcatheter devices warrant further investigation. For instance, the single-leaflet design of the Trisol valve, with its high closing volume, can mitigate the sharp increase in afterload that follows the reduction of TR.

In conclusion, while TTVR shows promise in addressing TR, careful consideration of RV function and ongoing research into device-specific impacts on afterload are essential to optimize patient outcomes.

Transvenous leads and transcatheter tricuspid valve devices

The incidence of TR increases exponentially in patients with implanted cardiac electronic devices[58]. This increase is significantly attributed to the leads passing through the tricuspid valve, which can directly interfere with the normal movement of the leaflets, preventing them from closing completely[59]. Prolonged lead friction may also cause structural degeneration or damage to the tricuspid valve[60]. Additionally, long-term interactions can lead to an inflammatory response, resulting in local fibrosis or scar formation, which further impairs leaflet function[61].

Endocardial leads can become trapped between the valve stent and the endocardium, resulting in transvenous lead entrapment. 

In the TRISCEND trial, all nine patients with pre-existing pacemakers had their right ventricular leads trapped by the Evoque valve[37]. If a trans-tricuspid lead becomes trapped, it cannot be fully removed in the event of device infection, necessitating alternative surgical extraction and prolonged antibiotic therapy, both of which carry significant mortality risks. In cases of device infection, prolonged suppressive antibiotic therapy has been associated with a 25% mortality rate at one month post-hospitalization and a 90% mortality rate at five years, with an estimated median survival of 1.43 years. Additionally, 18% of patients experience recurrence within one year[62]. The need for surgical extraction also poses serious morbidity risks, particularly in the population undergoing TTVR due to high surgical risk.

In appropriate patients, percutaneous transvenous lead extraction (TLE) may be considered prior to the TTVR procedure[63]. It is important to consider that in patients with TR, the lead may have been embedded or formed scar tissue due to prolonged presence. Removing the lead may further damage the tricuspid valve, leading to more severe regurgitation or acute valve dysfunction. In the ELECTRa registry, out of 3,555 patients who underwent TLE, 0.02-0.59% experienced worsening of tricuspid valve function post-TLE[64]. Polewczyk A et al. reported that in a study of 2,631 patients, 2.5

Conclusion

TR is no longer overlooked, as it significantly contributes to cardiac morbidity and mortality. With the rapid advancement of TTVR therapies, tricuspid regurgitation can now be effectively corrected, avoiding the adverse risks associated with traditional surgery.

TTVR devices offer clear advantages over surgical tricuspid valve replacement and transcatheter repair, reducing mortality and complication rates while effectively treating TR. Additionally, TTVR devices are less dependent on anatomical factors and the underlying TR etiology. Although some devices have received clinical approval, research on TTVR remains limited. Further studies with larger populations, longer follow-ups, and standardized management strategies are needed to advance this field.

Early feasibility studies show promising results and ongoing research continues to explore TTVR’s potential. For patients with severe TR who lack other treatment options, TTVR offers significant hope for the future.

Abbreviations

Abbreviations

CAVI     :Caval valve implantation

CE          :Conformité Européene           

ESC        :European Society of Cardiology 

EACTS  :European Association for Cardio-Thoracic Surgery

FDA       :Food and Drug Administration               

MR         :Mitral regurgitation

OAC       :Oral anticoagulation

RA          :Right atrium

RV          :Right ventricle

TLE        :Transvenous lead extraction

TR          :Tricuspid regurgitation

TTVI      :Transcatheter tricuspid valve intervention

TTVr      :Transcatheter tricuspid valve repair

TTVR     :Transcatheter tricuspid valve replacement

TV          :Tricuspid valve

Author Contribution:

Conceptualization, X.Z. and G.L.; methodology, G.L.; data curation, D.M., S.L.S.; writing—original draft preparation, Z.X., G.L. and N.S.P; writing—review and editing, T.P., D.M., S.L.S., D.F., G.W., O.J.M., H.S., T.A. and R.B.; visualization, D.F. and H.S.; supervision, G.L.; project administration, G.L.; funding acquisition, G.L. All authors have read and agreed to the published version of the manuscript.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

img

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

img

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

img

Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

img

Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

img

Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

img

Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

img

Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

img

Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

img

Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

img

Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

img

Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

img

Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

img

Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

img

Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

img

Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

img

Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

img

Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

img

Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

img

Dr David Vinyes