{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T14:03:56Z","timestamp":1789308236822,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Asian Cardiovasc Thorac Ann"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aortic stenosis is traditionally categorised as degenerative calcific, congenital bicuspid, or rheumatic. Contemporary molecular biology, multimodality imaging, and transcatheter valve therapy demonstrate that aortic stenosis represents a spectrum of mechanistically distinct diseases converging upon a shared haemodynamic endpoint. A four-category pathobiologic classification is proposed linking disease mechanism to operative strategy and procedural risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative mechanistic review was performed using contemporary international guidelines, foundational biological studies, and key clinical series. Pathophysiology, characteristic imaging phenotype, and procedural implications were integrated into a clinically applicable framework for use by multidisciplinary heart valve teams.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Aortic stenosis arises via common downstream pathways \u2013 valve interstitial cell activation, inflammation, extracellular matrix remodelling, and mineralisation \u2013 through mechanistically distinct initiating processes. Four phenotypes are identified: (a) congenital structural-biomechanical disease; (b) fibro-calcific inflammatory-osteogenic disease; (c) autoimmune\/inflammatory valvulitis; and (d) metabolic\/mineralisation-associated disease. Each demonstrates characteristic anatomical morphology, rate of haemodynamic progression, and differential suitability for transcatheter or surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Aortic stenosis is a final common phenotype of multiple distinct biological processes. A pathobiologic classification improves procedural planning, risk stratification, and therapeutic selection in the era of transcatheter valve therapy, and supports precision-based individualised patient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02184923261487490","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:44:19Z","timestamp":1789047859000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A pathobiologic classification of aortic stenosis: Moving beyond the degenerative\u2013bicuspid\u2013rheumatic paradigm"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-3358","authenticated-orcid":false,"given":"Sunil K.","family":"Ohri","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.035"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.015"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60211-7"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000155623.48408.C5"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.006767"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.08.013"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.114.302523"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027776"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000047200.36165.B8"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514616"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814052"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816885"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.01.039"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.1.81"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.740878"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.110.221358"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000027905.26586.E8"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.09091437"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.017"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.16.4.523"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.066"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200008313430903"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.9.2262"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.495903"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(05)70267-X"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg414"},{"key":"e_1_3_3_29_2","first-page":"217","article-title":"Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors","volume":"20","author":"Urena P","year":"1999","unstructured":"Urena P, Malergue MC, Goldfarb B, et al. Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors. 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