The Web of Science Core Collection (WOSCC) database, an authoritative source for indexing high-quality literature, is frequently selected for bibliometric analyses in various fields, including natural sciences, arts and humanities, engineering and technology, social sciences, and biomedical sciences (21, 22). To improve data availability, the WOSCC database was queried for literature related to the health management of patients undergoing valve replacement. The data search strategies were as follows: {[TI = (“valve replace*” or “valve implant*”)] OR AK = [“valve replace*” or “valve implant*”]} AND TS = (monitor or surveillance or manage or management or administer). The period selected for literature review was between January 1, 2013, and December 31, 2022. Two independent researchers (XHW and YW) completed the literature search. To prevent errors resulting from database updates, the investigation was concluded on January 1, 2023. The relevant information, such as title, abstract, keywords, references, authorship, and article sources, was saved in “txt” format for further analysis.

The records collected from WOSCC were exported to plain text files and then imported into VOSviewer 1.6.18 and CiteSpace 5.8.R3 for bibliometric analysis and visualization. The flowchart is shown in Figure 1.

VOSviewer, a widely used tool for bibliometric analysis, can provide practical visualization effects and highlight connections between materials (23, 24). This software has a powerful bibliometric map function that generates networks of countries, keywords, authors, and other relevant factors (25). In this study, VOSviewer was used to visualize networks of countries, institutions, authors, co-cited authors, and co-cited journals to show general information and global research progress on managing the health of patients undergoing valve replacement.

CiteSpace, which was designed by Professor Chaomei Chen at Drexel University, is a Java application that enables the generation of maps demonstrating the evolution of data from various perspectives (26). In particular, CiteSpace can identify collaborative networks among countries, references, and authors and identify the key turning points and the most widely cited bursts in a specific field (27). In this study, CiteSpace was used to exhibit reference bursts, keyword bursts, and a timeline viewer of keywords to explore the progression of research hotspots and predict future developments in the health management of patients undergoing valve replacement.

Several types of manuscripts, such as articles, reviews, editorial materials, meeting abstracts, proceeding papers, letters, early accesses, book chapters, corrections, and retracted publications were available in the literature (Figure 2A). This study focused on articles and reviews. Based on the search strategy, 2,771 publications comprising 2,236 articles and 535 reviews were retrieved. Additionally, the number of annual and cumulative publications broadly exhibited an upward trend (Figure 2B). From 2013 to 2017, the growth rate of publication volume was low (an average of 170 publications per year). Since 2018, the growth rate of publication volume rapidly increased (>300 publications per year). In 2021, 471 papers were published, indicating that the health management of patients undergoing valve replacement piqued the interest of the scientific community. The number of publications in 2022 was lower than that in 2021. However, the number of publications in 2022 was as high as 375, indicating sustained research interest in this area.

Between 2013 and 2022, 91 countries (37 high-income and 54 low-income and middle-income countries) contributed to the literature on the health management of patients undergoing valve replacement. Only seven low-income and middle-income countries were among the top 30 contributors to publication volume. This indicated that the research in this field in high-income countries was higher than that in low-income and middle-income countries, which may be related to publication bias. The most productive country was the United States of America (USA) (N = 921; 33.24%), followed by Germany (N = 380; 13.71%) and Italy (N = 318; 11.48%) (Table 1; Figure 3A). The USA, Germany, and Italy accounted for more than half of all publications in this field. Collaborative efforts between nations are critical for scientific research and medical advancement. As shown in Figure 3B, the USA had the highest total link strength and cooperation relationship, especially with Canada, followed by Germany, Italy, the United Kingdom, and France. Although China and Japan were ranked among the top 10 countries contributing to publication volume, their cooperation intensity with other nations was inadequate.

Additionally, 3,601 institutions were involved in this study. Among the top 10 organizations ranked according to publication volume, six were in the USA, three were in Canada, and one was in Italy (Table 1). The Mayo Clinic was the most prolific research organization performing studies on the health management of patients undergoing valve replacement (N = 112, 4.93%), followed by Columbia University (N = 88, 3.87%) and Cleveland Clinic (N = 70, 3.08%). The increased academic exchanges have contributed to inter-institutional collaborations. This study provided an illustrative network visualization among these organizations (Table 1; Figure 3C). Columbia University exhibited the highest total link strength (N = 956) and the closest cooperative relationship with the Cardiovascular Research Foundation, while the Mayo Clinic exhibited the most immediate cooperation with the University of Pennsylvania.

In the last decade, 14,197 authors contributed to studies on the health management of patients undergoing valve replacement. The most productive author was Rodes-Cabau J (Quebec Heart & Lung Institute, Canada) with 75 publications, followed by Sondergaard L (Glenfield Hospital, Denmark) and Barbanti M (University of Catania, Italy) with 50 and 44 publications, respectively (Table 2). Long-term collaboration between researchers enhances the influence of authors and facilitates the development of patient health management strategies. Figure 4A shows the collaboration network among authors. Rodes-Cabau J conducted frequent academic collaborations with Nombela-Franco L, Urena M, and Dumont E, who were affiliated with the Quebec Heart & Lung Institute. Co-citation analysis enables the identification of authors who had the highest contributions to studies on the health management of patients undergoing valve replacement (Figure 4B). Leon MB was the most frequently co-cited author despite ranking fifth in publication volume, suggesting that the results from this team have gained high recognition and reference value. Moreover, Leon MB and Smith CR exhibited the closest co-citation relationship, indicating that they share similar research topics and are often cited together by other authors.

In total, 2,771 articles related to the health management of patients undergoing valve replacement were distributed across 525 journals. Table 3 displays the top 10 journals sorted according to publication volume. Impact factor (IF) and journal citation reports were also presented to weigh the scientific research quality of journals. The three most common journals in which the articles were published were Catheterization and Cardiovascular Interventions (133 papers, IF: 2.585), Journal of Cardiothoracic and Vascular Anesthesia (89 papers, IF: 2.894), and American Journal of Cardiology (84 papers, IF: 3.133). In addition to the number of published articles, the influence of the journal is dependent on the frequency of citations. Journal of the American College of Cardiology, Circulation, and New England Journal of Medicine were among the most frequently co-cited journals (Citation > 5,000) with a high level of influence (Figure 5A). To visualize the analysis, journal documents, citation frequency, and total link strength over time were also presented (Figure 5B). Journal of the American College of Cardiology had the highest total link strength and citation, reflecting its importance in publishing studies on the health management of patients undergoing valve replacement. Furthermore, a heatmap was used to depict the annual publication trends of the top 30 productive journals between 2013 and 2022 (Figure 5C). Publications on the health management of patients undergoing valve replacement rapidly increased in more than half of the journals since 2018. Journals publishing these studies had the best publication trend in 2021.

To identify critical literature, the top 10 references cited by articles related to the health management of patients undergoing valve replacement were examined (Table 4). Seven, two, and one references were published in the New England Journal of Medicine (IF: 176.079), the Journal of the American College of Cardiology (IF: 27.203), and the European Heart Journal (IF: 35.855), respectively. The most cited reference was “Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery” with 597 citations, followed by “Transcatheter vs. Surgical Aortic-Valve Replacement in High-Risk Patients” with 557 citations. Despite the perioperative risks, these two studies suggested that transcatheter aortic valve replacement was a viable alternative for high-risk patients with aortic stenosis and emphasized the importance of informed decision-making and optimal surgical approach (28, 29). The third most cited study was “Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patient” with 463 citations. This study evaluated intermediate-risk patients with aortic stenosis and demonstrated that the outcomes of transcatheter aortic valve replacement were comparable to those of surgical aortic valve replacement in terms of the primary endpoint of death or disabling stroke over two years (30).

To address the concerns about the health management of patients undergoing valve replacement, the top 25 references exhibiting the strongest citation bursts were analyzed and chronologically presented (Figure 6). The focus from 2013 to 2022 was analyzed. Among the studies from 2020 to 2022, the references published by Mack MJ (31) and Popma JJ (32) exhibited increased bursts. Both articles compared the composite endpoint incidence of death and stroke after transcatheter aortic valve replacement and surgical aortic valve replacement at one or two years. The short-term outcomes of transcatheter aortic valve replacement were similar to those of surgical aortic valve replacement in low-risk patients with the added benefit of short recovery time.

The research hotspots and frontiers were analyzed by examining author keywords, which encapsulate the main ideas of the manuscript. Before analysis, the keywords were consolidated to obtain 3,815 author keywords. Table 5 shows the top 10 author keywords with the highest frequency and the author keywords related to management. Among the author keywords, six were linked to aortic valve disease, indicating a significant focus on the health management of patients undergoing aortic valve replacement. The author keywords related to management were divided into the following four categories: anticoagulant management, implant management, complication management, and holistic nursing management. Anticoagulation management-related keywords were frequently used and included “anticoagulation” (72 times) and “warfarin” (39 times). Implant management-related keywords comprised “pacemaker” (62 times), “prosthesis” (56 times), and “bioprosthetic” (49 times). Complication management-related keywords comprised “complication” (67 times), “bleeding” (38 times), and “vascular complications” (35 times). Meanwhile, holistic nursing management-related keywords mainly comprised “quality of life” (24 times) and “frailty” (19 times).

Keyword burst refers to the frequent usage of keywords and enables the understanding of research forefront, changes in research focus, and the latest trends in research hotspots. The frequency of the keyword usage indicates the strength of the research focus. Figure 7A presents the top 25 keywords exhibiting the strongest citation bursts related to the health management of patients undergoing valve replacement. “High-risk patient” had the strongest citation bursts, followed by “corevalve”, “intermediate risk patient” and “prosthesis”. From a temporal perspective, “high risk patient”, “corevalve” and “prosthesis” emerged earlier and were subjects of early interest. Since 2018, “SAVR”, “intermediate risk”, “need” and “pacemaker implantation” have started to burst and continue until now. These findings revealed that the focus on the management of patients undergoing valve replacement shifted from “high-risk patient” to “intermediate risk.”

CiteSpace can depict a timeline analysis of keywords, explore hot keywords’ rise and fall process, and study the vein of a certain field. The adjustment parameters yielded 12 clusters. Five clusters containing the highest number of keywords are shown in Figure 7B. The largest cluster was labeled “Aortic valve replacement,” suggesting an increased focus on aortic valve replacement. The focus progressively shifted from adverse event management to cardiac rehabilitation management with prevalent keywords, such as “frailty,” “risk stratification,” “recovery,” and “repair system.”

In this study, 2,771 articles on the health management of patients undergoing valve replacement were searched. The increased number of publications indicates an increasing interest in the health management of patients undergoing valve replacement. In particular, more than 300 papers were published annually since 2018 with the highest number of publications in 2021. High-income countries, especially the USA, contributed to studies on the health management of patients undergoing valve replacement. China and Japan ranked among the top 10 countries contributing to publication although their total link strengths were relatively weak, indicating less international cooperation and increased internal collaboration in academic research. To break through these academic barriers, we recommend that Chinese and Japanese researchers strengthen their exchanges with international institutions that have published multiple authoritative publications in this field, such as Mayo Clinic, Columbia University, and Cleveland Clinic. Additionally, research in low-income and middle-income countries should be improved and linked with high-income countries to avoid publication bias and maintain a scientific balance.

In this study, Italy ranked third in terms of publication numbers and total link strength. However, none of the top 10 co-cited authors were affiliated with institutions in Italy, suggesting that the scientific impact of Italian researchers is inadequate and the research quality must improve. Leon MB from Columbia University in the USA was the most co-cited author. Additionally, the publications of Leon MB received several citations, establishing the author as an expert in the health management of patients undergoing valve replacement. Among the academic journals related to the management of patients undergoing valve replacement, the average IF for the top 10 co-cited journals was 31.192, suggesting that articles published in authoritative journals can pique the interest of the researchers and shape the development trends of the field. Journal of American College of Cardiology had the highest number of citations and total link strength, indicating that it is a relatively mainstream and authoritative journal on studies related to the management of patients undergoing valve replacement.

This novel bibliometric analysis of studies on the management of patients undergoing valve replacement had some limitations. As this study retrieved literature from the WOSCC database, relevant literature published in other databases was not analyzed. Additionally, bibliometrics can provide a comprehensive overview of research progress but cannot assess the quality of individual documents. Furthermore, incomplete keyword extraction by software and the diversity of subject terms may affect the number of keywords. To address this limitation, important keywords were manually consolidated to identify the current hotspots and frontiers in patient management after valve replacement surgery. Despite these limitations, this study provides useful insights into the health management of patients undergoing valve replacement, guides the development of disciplines, and enables clinical applications in this field.