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Heart valve disease is a major component of heart disease and the significance of this disease is rising primarily due to increasing life expectancy as well as new percutaneous treatments becoming available to older patient populations who would otherwise only receive medical management. Treatments for severe heart valve disease vary from replacement with prosthetic heart valves or performing repair or implantation of palliative devices to improve valvular function. Unfortunately, current and past replacement and repair devices have not ‘‘solved’’ the problem due to continuing issues related to occurrence of complications (e.g. thromboembolism, need for pacemaker etc.) or compromise of valve function (e.g. structural deterioration of prosthetic leaflets, recurrence of mitral regurgitation after repair, valve leakage etc.) or the unintended introduction of a new problem (e.g. new issues resulting from the need for anticoagulation therapy). This explains the strong need and the current pursuit of engineering the ideal heart valve replacement or repair, which is the focus of this special edition. Two review articles are presented: (a) review by Dasi et al. on the mechanics of transcatheter aortic valve replacement (TAVR) which focuses on the current issues related to TAVR; and (b) the review by Espiritu et al. which focuses on trans-catheter mitral valve repair therapies. We have limited the reviews to transcatheter approaches alone for the aortic and mitral technologies given that numerous other review articles exist on the more traditional heart valve replacement and repair technologies. So what would be the ideal heart valve replacement or repair solution? While the best solution is prevention of valve disease, we will not be discussing preventative approaches in this edition because that would entail engineering in a different sense—understanding the pathophysiology of valve disease and engineering an intervention aimed to arrest or reverse disease progression. Here we focus on engineering new devices that will overcome the limitations of current replacement or repair devices. Two broad strategies emerge: (A) engineer a living tissue engineered heart valve that can replace the diseased heart valve and be immune to deterioration or disease processes or (B) engineer replacement or repair devices that are not biological in nature to overcome the limitations of current devices. Both strategies continue to be challenging because the mechanics of heart valves is inherently complex and unfortunately the heart valve engineering community does not yet fully understand the principles dictating how living tissue responds to mechanics or how a given valve design with novel synthetic materials would perform in vivo. Basic studies addressing this knowledge gap is progressing and a few articles are noteworthy along these efforts. The work presented by Kang et al. contributes to the body of knowledge that aims to 3D print cardiovascular soft tissues such as heart valves. Here they have elucidated the importance of stress mechanisms in the context of optimizing photo-encapsulation viability of heart valve cells for 3D printing applications. The article by Khalighi et al. aims to take advantage of regularities in the mitral valve structure to improve current mitral valve repair Lakshmi Prasad Dasi Jane Grande-Allen

The Pursuit of Engineering the Ideal Heart Valve Replacement or Repair: A Special Issue of the Annals of Biomedical Engineering