Current status and future perspective of structural heart disease intervention

Abstract

Valvular heart diseases are one of the most frequent causes for heart failure. Degenerative diseases of the aortic and mitral valve as well as a dysfunctional tricuspid valve disease result in a worse clinical outcome if severe. Minimal-invasive, surgical and/or catheter-based structural heart disease (SHD) interventions have recently seen a dramatic increase. Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is a disruptive technology, and next generation devices and careful patient selection will minimize limitations of TAVI such as paravalvular leak, conductance disturbances, ischemic stroke, and vascular complications. The indication of TAVI continues to shift toward lower risk patients and patients with complex anatomy such as bicuspid AS or native pure aortic regurgitation. Successful clinical results in TAVI have generated considerable interest in further transcatheter technologies targeting mitral regurgitation (MR) and also toward tricuspid regurgitation (TR). The efficacy and safety of edge-to-edge with or without annuloplasty leaflet repair mimicking surgical repair will have to be confirmed by technical improvement, device development, and further emerging studies. Transcatheter mitral valve implantation might be an alternative strategy in patients with symptomatic severe MR and favorable anatomy. Possible interventional treatment approaches for TR have gained more attention. Improvement and development of SHD interventions have enabled more patients to receive minimally invasive heart valve interventions and these procedures have prolonged life and/or improved quality of life for many patients who were previously considered unsuitable for surgery. Continued technical and device improvements and accumulated evidence will expand its possibility and future of SHD interventions.

Keywords: mitral regurgitation; structural heart disease intervention; transcatheter aortic valve implantation; tricuspid regurgitation.