Percutaneous Heart Valve Therapy โ€“ Options, Risks and Benefits

European Cardiology Review, 2010;6(1):65-74

Abstract

Transcatheter valve therapy is emerging as an effective option for aortic valve stenosis and mitral regurgitation. In 1992, Anderson demonstrated the feasibility of percutaneous implantation of catheter-based valve prosthesis. Since then, many technical and device advances have been made, and transcatheter aortic valve implantation and mitral valve repair have became a concrete alternative to surgical replacement.
Keywords
Aortic stenosis, mitral regurgitation, replacement, repair, transcatheter
Disclosure Gian Paolo Ussia is proctor physician for CoreValveยฎ. The remaining authors have no conflicts of interest to declare.
Received: August 11, 2009 | Accepted October 30, 2010 | Citation European Cardiology Review, 2010;6(1):65-74
Correspondence: Corrado Tamburino, Director of Cardiology Division, Post-graduate School of Cardiology, Ferrarotto Hospital, University of Catania, Italy. E: tambucor@unict.it

Valvular heart disease is one of the most discussed health topics, as it is often associated with significant morbidity and mortality. To date, aortic stenosis (AS) and mitral regurgitation (MR), respectively, are the first and second most common heart valve diseases in western countries. It has been extensively demonstrated that surgical treatment with valve repair or replacement with mechanical or bioprosthetic valve implantation can modify the natural history of the disease course, yielding excellent short- and long-term results, justifying their role as โ€˜gold-standardโ€™ therapies for these pathologies.1,2 However, these procedures are also associated with significantly higher rates of immediate and long-term complications in an expanding subgroup of patients (in particular the elderly and patients with several co-morbidities); this phenomenon has led to an increasing incidence of patients affected by critical MR and AS who are denied or refused surgery.3,4 The advent of transcatheter interventional techniques such as percutaneous valve implantation or repair offers a unique opportunity to treat patients in this subgroup who were, until now, considered to be poor candidates for conventional surgical treatment. In this respect, the development of percutaneous valve techniques is evocative of the evolution of percutaneous treatment of coronary artery disease. Catheter-based treatment of valvular heart disease was investigated in 1992 when Andersen demonstrated the feasibility of percutaneous โ€˜closed-chestโ€™ implantation of transcatheter aortic valve bioprosthesis in animal models.5 In 2000, Philippe Bonhoeffer6 reported the first transcatheter implantation of a stent-mounted bovine jugular vein valve in the pulmonary position. Two years passed before the first human implantation of a percutaneous aortic valve, which was performed by Alain Cribier in a inoperable patient affected by severe symptomatic AS.7 Finally, percutaneous treatment of MR is the latest frontier that interventional cardiology has been exploring.8 A lot of technical and device advances have been made and transcatheter aortic and mitral valve therapy, after some controversy, is becoming more than an โ€˜idealโ€™.

Percutaneous Aortic Valve Therapy

AS has been the focus of percutaneous treatments since the mid- 1980s. Aortic valvuloplasty for AS had historically been performed with direct vision.9 Catheter-based percutaneous valvuloplasty had been attempted with good short- and long-term results in paediatric populations, and has remained the procedure of choice in congenital AS.10

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