Integrating Multidisciplinary Care and Advanced Therapies in Heart Failure for Complex Structural Heart Disease

Complex structural heart disease (SHD) introduces a wide spectrum of anatomical and physiological challenges that fundamentally alter the management of heart failure (HF). Patients with congenital heart disease across the lifespan, those with acquired structural lesions such as multivalve pathology or significant regurgitation with advanced remodeling, and individuals in post surgical or post transcatheter intervention states often experience persistent or evolving heart failure symptoms. In these scenarios, standard guideline directed HF therapies serve as an important baseline, but the presence of residual defects, altered loading conditions, pulmonary vascular involvement, and multi chamber dysfunction frequently require departures from conventional care models. Notably, existing HF evidence bases often fail to capture the nuanced decision making that these complex patient populations require, resulting in significant gaps in evidence and care.This Research Topic aims to highlight and advance anatomy driven, physiology informed strategies for the management of HF in complex SHD. We seek to unify perspectives and expertise from heart failure and transplantation, adult and pediatric congenital cardiology, structural and interventional cardiology, advanced cardiac imaging, electrophysiology, surgery, and critical and supportive care disciplines. The primary objective is to clarify how nuanced structural and physiological abnormalities inform every stage of HF care, from diagnostics and phenotyping to therapeutic selection, timing, and escalation of interventions. We encourage both the presentation of novel therapies and the delineation of multidisciplinary care pathways, supported wherever possible by advanced imaging and invasive hemodynamics, to enable tailored and effective shared decision making.To maintain a unique focus and avoid overlap with more general heart failure topics, submissions must specifically address HF management challenges shaped by complex structural anatomy, abnormal physiology, or post intervention states, and ideally incorporate imaging based or hemodynamic assessment, or detailed multidisciplinary pathway design. The scope encompasses, but is not limited to:• Imaging and hemodynamic phenotyping to clarify actionable contributors to HF (including residual lesions, complex valve disease, shunts, right ventricular to pulmonary artery coupling, restrictive or mixed physiology, or ventricular interaction);• Strategies for tailoring and monitoring guideline directed medical therapy in complex substrates such as single ventricle or Fontan, systemic RV, severe valvulopathies, or those with major cardiorenal or cardiohepatic comorbidities;• Sequencing and selection of surgical or transcatheter interventions for optimal HF trajectory, and their integration with medical and rhythm therapies;• Advanced mechanical circulatory support (temporary and durable MCS), VADs, and transplantation, including candidacy, bridging, and post procedural care with a focus on nonstandard anatomies;• Integration of device therapies (CRT, ablation, ICDs) and rhythm management within HF plans for atypical cardiac anatomy;• Implementation and outcomes of multidisciplinary models (such as ACHD HF clinics, structural valve and HF conferences, multispecialty shock teams, and cardiohepatic clinics) to optimize time to intervention, coordination, and patient experience;• Transitions in care, including pediatric to adult pathways and strategies for reducing disparities in access to advanced HF therapies. Topic editors: Julia Grapsa, Nadira Hamid Source: https://www.frontiersin.org/research-topics/78814/integrating-multidisciplinary-care-and-advanced-therapies-in-heart-failure-for-complex-structural-heart-disease